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809 Highway 466 Ste C102 Lady Lake FL 32159-3909 | |
| (352) 336-8478 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 809 Highway 466 Ste C102, Lady Lake, Florida |
| Authorized Official Name and Position | Igor German (MBR) |
| Authorized Official Contact | 3522849045 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
13979 Nw 30th Ave Gainesville FL 32606-9311 Ph: (352) 284-9045 | 809 Highway 466 Ste C102 Lady Lake FL 32159-3909 Ph: (352) 336-8478 |
| NPI Number | 1447096334 |
|---|---|
| Provider Enumeration Date | 07/01/2024 |
| Last Update Date | 08/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447096334 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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