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General NPI Number Information
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NPI Number | 1538436522
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Entity Type | Organization
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Legal Business Name | EVERGLADES PEDIATRIC DENTISTRY, LLC
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Dates
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Enumeration Date | 11/19/2011
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Last Update Date | 11/19/2011
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Provider Practice Location Address
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Address Line | 2029 HIGHWAY 441 NORTH
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City | OKEECHOBEE
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State | FL
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Zip | 34972
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Country | US
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Telephone | 863-467-2332
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Fax | 863-467-2347
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Provider Business Mailing Address
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Address Line | 2029 HIGHWAY 441 NORTH
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City | OKEECHOBEE
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State | FL
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Zip | 34972
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Country | US
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Telephone | 863-467-2332
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Fax | 863-467-2347
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Authorized Official
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Title or Position | OWNER / DOCTOR
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Name | DR. MELISSA KINDELL
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Credential | D.M.D.
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Telephone | 863-467-2332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN16660
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License Number State | FL
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