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General NPI Number Information
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NPI Number | 1053235143
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Entity Type | Organization
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Legal Business Name | SANTA ROSA BEACH FAMILY DENTAL LLC
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Dates
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Enumeration Date | 08/10/2026
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Last Update Date | 08/10/2026
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Provider Practice Location Address
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Address Line | 3570 US HWY 98 W
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459
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Country | US
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Telephone | 850-428-0901
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Fax |
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Provider Business Mailing Address
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Address Line | 1848 GREAT HAMMOCK BND
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City | FREEPORT
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State | FL
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Zip | 32439-6695
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Country | US
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Telephone | 850-953-7005
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COLLIN MYRICK
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Credential | DDS
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Telephone | 850-428-0901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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