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General NPI Number Information
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NPI Number | 1649907809
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Entity Type | Organization
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Legal Business Name | AQUIDEL DENTAL SERVICES, LLC
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Dates
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Enumeration Date | 08/06/2022
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Last Update Date | 08/06/2022
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Provider Practice Location Address
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Address Line | 11574 SW VILLAGE PKWY
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-2392
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Country | US
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Telephone | 772-204-3113
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Fax |
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Provider Business Mailing Address
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Address Line | 11574 SW VILLAGE PKWY
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-2392
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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 | BILLING STAFF
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Name | MYRENE MYRENE
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Credential |
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Telephone | 516-596-8123
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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 |
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License Number State |
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