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General NPI Number Information
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NPI Number | 1255782553
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Entity Type | Organization
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Legal Business Name | FLORIDA DENTISTRY GROUP INC.
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 115 JFK DR
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City | ATLANTIS
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State | FL
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Zip | 33462-1152
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Country | US
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Telephone | 561-967-3513
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Fax | 561-967-4705
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Provider Business Mailing Address
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Address Line | 115 JFK DR
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City | ATLANTIS
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State | FL
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Zip | 33462-1152
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Country | US
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Telephone | 561-967-3513
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Fax | 561-967-4705
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Authorized Official
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Title or Position | DIRECTOR
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Name | DONALD E NEWMAN
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Credential | D.D.S.
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Telephone | 561-967-3513
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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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