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General NPI Number Information
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NPI Number | 1629211735
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Entity Type | Organization
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Legal Business Name | ECONOMY DENTURES OF LAKE MARY
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | 890 S SUN DR
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City | LAKE MARY
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State | FL
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Zip | 32746-2406
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Country | US
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Telephone | 407-333-3508
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Fax | 407-804-5189
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Provider Business Mailing Address
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Address Line | 1680 DUNN AVE SUITE 31
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City | JACKSONVILLE
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State | FL
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Zip | 32218-4782
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Country | US
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Telephone | 904-696-6767
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. WENDY GAIL KIMBRELL
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Credential |
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Telephone | 904-696-6767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN8243
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License Number State | FL
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