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General NPI Number Information
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NPI Number | 1205067725
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Entity Type | Organization
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Legal Business Name | KIDS ONLY DENTAL PLACE
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 07/31/2009
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Provider Practice Location Address
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Address Line | 5209 SW 91ST DR
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City | GAINESVILLE
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State | FL
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Zip | 32608-3028
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Country | US
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Telephone | 352-335-7777
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Fax | 352-371-3430
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Provider Business Mailing Address
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Address Line | 5209 SW 91ST DR
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City | GAINESVILLE
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State | FL
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Zip | 32608-3028
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Country | US
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Telephone | 352-335-7777
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Fax | 352-371-3430
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT N MIXON
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Credential | D.M.D., P.A.
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Telephone | 352-335-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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