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General NPI Number Information
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NPI Number | 1033774757
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Entity Type | Organization
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Legal Business Name | VICTORIAN DENTAL
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 131 VICTORIA COMMONS BLVD
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City | DELAND
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State | FL
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Zip | 32724
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Country | US
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Telephone | 386-624-7658
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Fax | 386-873-4625
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Provider Business Mailing Address
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Address Line | 1431 ORANGE CAMP RD STE 108
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City | DELAND
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State | FL
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Zip | 32724-7769
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Country | US
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Telephone | 386-624-7658
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Fax | 386-873-4625
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER HAMILTON RAE
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Credential | DMD
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Telephone | 386-624-7658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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