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General NPI Number Information
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NPI Number | 1932554425
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Entity Type | Organization
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Legal Business Name | ALL DENTAL, PLLC
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 05/03/2016
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Provider Practice Location Address
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Address Line | 1525 COMMERCIAL WAY
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City | SPRING HILL
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State | FL
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Zip | 34606-4527
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Country | US
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Telephone | 352-200-5345
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Fax | 352-688-2542
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Provider Business Mailing Address
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Address Line | PO BOX 3189
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City | SYRACUSE
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State | NY
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Zip | 13220-3189
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Country | US
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Telephone | 315-454-6000
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Fax | 315-410-5531
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Authorized Official
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Title or Position | PROVIDER RELATIONS SPECIALIST
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Name | KIM VAN CAMP
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Credential |
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Telephone | 315-454-6000
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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 | DN21028
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License Number State | FL
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