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General NPI Number Information
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NPI Number | 1356724264
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Entity Type | Organization
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Legal Business Name | TRINITY ENDODONTICS OF GREATER WINTER HAVEN
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Dates
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Enumeration Date | 07/09/2015
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Last Update Date | 07/09/2015
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Provider Practice Location Address
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Address Line | 317 CYPRESS GARDENS BLVD
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City | WINTER HAVEN
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State | FL
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Zip | 33880
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Country | US
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Telephone | 863-875-4823
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Fax | 863-875-5564
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Provider Business Mailing Address
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Address Line | 317 CYPRESS GARDENS BLVD
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City | WINTER HAVEN
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State | FL
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Zip | 33880-4452
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Country | US
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Telephone | 863-875-4823
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Fax | 863-875-5564
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Authorized Official
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Title or Position | DENTIST
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Name | DR. TERRYL M. CRAWFORD
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Credential | DMD, MSD
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Telephone | 863-875-4823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | DN16500
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License Number State | FL
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