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General NPI Number Information
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NPI Number | 1346554391
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Entity Type | Organization
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Legal Business Name | DENTAL PRACTICE GROUP OF FLORIDA
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Dates
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Enumeration Date | 08/02/2010
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 8586 EDEN ISLES LN
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-6800
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Country | US
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Telephone | 321-412-3239
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Fax | 321-722-0994
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Provider Business Mailing Address
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Address Line | 8586 EDEN ISLES LN
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-6800
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Country | US
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Telephone | 321-412-3239
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Fax | 321-722-0994
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. TODD EDWARD CHRISTIE
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Credential | D.M.D.
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Telephone | 321-412-3239
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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 | 14545
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License Number State | FL
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