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General NPI Number Information
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NPI Number | 1790836294
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Entity Type | Organization
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Legal Business Name | PALM TREE DENTAL CENTER
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Dates
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Enumeration Date | 01/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6200 20TH ST STE 292
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City | VERO BEACH
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State | FL
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Zip | 32966-1079
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Country | US
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Telephone | 772-778-5773
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Fax | 772-778-6944
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Provider Business Mailing Address
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Address Line | 6200 20TH ST STE 292
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City | VERO BEACH
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State | FL
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Zip | 32966-1079
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Country | US
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Telephone | 772-778-5773
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Fax | 772-778-6944
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES WITULSKI
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Credential | DDS
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Telephone | 772-778-5773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN0013338
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License Number State | FL
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