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General NPI Number Information
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NPI Number | 1700707247
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Entity Type | Organization
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Legal Business Name | CRESTVIEW DENTAL CARE PLLC
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Dates
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Enumeration Date | 07/22/2026
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Last Update Date | 07/22/2026
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Provider Practice Location Address
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Address Line | 838 W JAMES LEE BLVD
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City | CRESTVIEW
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State | FL
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Zip | 32536-5166
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Country | US
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Telephone | 850-689-1858
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Fax |
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Provider Business Mailing Address
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Address Line | 838 W JAMES LEE BLVD
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City | CRESTVIEW
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State | FL
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Zip | 32536-5166
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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 | OWNER
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Name | PETER KELLY
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Credential |
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Telephone | 407-432-6224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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