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General NPI Number Information
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NPI Number | 1124795000
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Entity Type | Organization
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Legal Business Name | DENTAL ARTS STUDIO
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Dates
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Enumeration Date | 08/27/2021
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Last Update Date | 08/27/2021
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Provider Practice Location Address
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Address Line | 154 W STATE ROAD 434
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-2551
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Country | US
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Telephone | 407-327-1964
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Fax |
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Provider Business Mailing Address
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Address Line | 311 SONG BIRD RD
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City | DEBARY
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State | FL
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Zip | 32713-3186
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Country | US
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Telephone | 305-762-0908
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MAELYS AGUILA-MITCHELL
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Credential |
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Telephone | 305-762-0908
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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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