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General NPI Number Information
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NPI Number | 1265500565
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Entity Type | Organization
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Legal Business Name | THE MAIN STREET DENTISTS INC
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 606 W MAGNOLIA STREET
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City | LEESBURG
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State | FL
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Zip | 34748
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Country | US
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Telephone | 352-787-4800
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Fax | 352-787-9091
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Provider Business Mailing Address
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Address Line | 606 W MAGNOLIA STREET
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City | LEESBURG
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State | FL
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Zip | 34748
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Country | US
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Telephone | 352-787-4800
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Fax | 352-787-9091
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Authorized Official
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Title or Position | DR & PRESIDENT OF CORPORATION
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Name | DR. JON DAVID MEHR
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Credential | DDS
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Telephone | 352-787-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN0014896
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN0014763
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License Number State | FL
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