| Banyan Dental Svc Psl, Llc | |
|
1707 Nw St. Lucie W. Blvd #126 Port Saint Lucie FL 34986 | |
| (772) 344-3300 | |
| (772) 344-3301 |
| Full Name | Banyan Dental Svc Psl, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1707 Nw St. Lucie W. Blvd, Port Saint Lucie, Florida |
| Authorized Official Name and Position | Jade E. Thomas (OWNER) |
| Authorized Official Contact | 7723443300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Banyan Dental Svc Psl, Llc 1707 Nw St. Lucie W. Blvd #126 Port Saint Lucie FL 34986 Ph: (772) 344-3300 | Banyan Dental Svc Psl, Llc 1707 Nw St. Lucie W. Blvd #126 Port Saint Lucie FL 34986 Ph: (772) 344-3300 |
| NPI Number | 1740603380 |
|---|---|
| Provider Enumeration Date | 02/03/2014 |
| Last Update Date | 02/03/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740603380 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN16485 (Florida) | Primary |
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