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1602 Cortez Rd W Bradenton FL 34207-1440 | |
| (315) 454-6000 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1602 Cortez Rd W, Bradenton, Florida |
| Authorized Official Name and Position | Mika Weiss (PROVIDER RELATIONS) |
| Authorized Official Contact | 3154546000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12019 Granite Woods Loop Venice FL 34292-4138 Ph: () - | 1602 Cortez Rd W Bradenton FL 34207-1440 Ph: (315) 454-6000 |
| NPI Number | 1275930729 |
|---|---|
| Provider Enumeration Date | 11/28/2014 |
| Last Update Date | 12/24/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275930729 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN19229 (Florida) | Primary |
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