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General NPI Number Information
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NPI Number | 1972394120
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Entity Type | Organization
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Legal Business Name | WOLCOTT DMD
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 1405 S HIAWASSEE RD
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City | ORLANDO
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State | FL
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Zip | 32835-5786
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Country | US
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Telephone | 407-294-6009
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Fax |
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Provider Business Mailing Address
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Address Line | 550 BRICKELL ST SE
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City | PALM BAY
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State | FL
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Zip | 32909-4471
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Country | US
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Telephone | 321-292-4058
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DESTINY WOLCOTT
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Credential | DMD
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Telephone | 321-292-4058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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