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General NPI Number Information
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NPI Number | 1588950349
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Entity Type | Organization
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Legal Business Name | ASSOCIATED ENDODONTISTS OF LAKE CITY
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 06/21/2011
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Provider Practice Location Address
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Address Line | 2086 SW MAIN BLVD STE 113
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City | LAKE CITY
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State | FL
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Zip | 32025-0006
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Country | US
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Telephone | 386-758-6050
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Fax | 386-758-7742
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Provider Business Mailing Address
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Address Line | 2086 SW MAIN BLVD STE 113
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City | LAKE CITY
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State | FL
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Zip | 32025-0006
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RECEIPTIONIST
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Name | STEPHANIE WALTERS
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Credential |
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Telephone | 386-758-6050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN 5418
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License Number State | FL
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