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General NPI Number Information
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NPI Number | 1184406704
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Entity Type | Organization
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Legal Business Name | MCDONNELL DENTAL CARE
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Dates
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Enumeration Date | 10/18/2023
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 1440 REED CANAL RD STE 101
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City | PORT ORANGE
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State | FL
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Zip | 32129-9460
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Country | US
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Telephone | 386-410-4943
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Fax | 386-339-0321
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Provider Business Mailing Address
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Address Line | 1440 REED CANAL RD STE 101
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City | PORT ORANGE
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State | FL
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Zip | 32129-9460
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Country | US
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Telephone | 386-410-4943
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Fax | 386-339-0321
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | JENIFER HARTMANN
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Credential |
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Telephone | 386-410-4943
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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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