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General NPI Number Information
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NPI Number | 1407775000
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Entity Type | Organization
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Legal Business Name | DT CLINICAL PORT ST LUCIE
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 1214 SW GATLIN BLVD UNIT 103
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-4216
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Country | US
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Telephone | 772-232-8186
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Fax | 561-922-7001
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Provider Business Mailing Address
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Address Line | 1214 SW GATLIN BLVD UNIT 103
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-4216
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Country | US
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Telephone | 772-232-8186
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Fax | 561-922-7001
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Authorized Official
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Title or Position | COO
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Name | BRYON ALMEIDA
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Credential |
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Telephone | 561-623-5320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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