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General NPI Number Information
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NPI Number | 1225850993
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Entity Type | Organization
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Legal Business Name | PENSACOLA EDC MANAGEMENT LLC
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 3101 W MICHIGAN AVE STE E
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City | PENSACOLA
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State | FL
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Zip | 32526-1876
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Country | US
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Telephone | 850-792-1841
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1740
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City | BELLEVUE
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State | NE
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Zip | 68005-1740
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Country | US
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Telephone | 402-658-4687
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL OBENG
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Credential |
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Telephone | 402-981-4136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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