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General NPI Number Information
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NPI Number | 1588029300
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Entity Type | Organization
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Legal Business Name | EVERGLADES PEDIATRIC DENTISTRY II
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Dates
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Enumeration Date | 12/21/2015
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 5606 US HIGHWAY 27 N
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City | SEBRING
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State | FL
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Zip | 33870-1211
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Country | US
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Telephone | 863-382-0340
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Fax | 863-357-7342
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Provider Business Mailing Address
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Address Line | 5606 US HIGHWAY 27 N
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City | SEBRING
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State | FL
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Zip | 33870-1211
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Country | US
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Telephone | 863-382-0340
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Fax | 863-357-7342
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MELISSA DANIELLE KINDELL
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Credential | DMD
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Telephone | 863-382-0340
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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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