|
| |
|
1770 N. Wickham Rd Melbourne FL 32935 | |
| (321) 253-0606 | |
| (321) 253-9848 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1770 N. Wickham Rd, Melbourne, Florida |
| Authorized Official Name and Position | Aracelly Montenegro (SENIOR MANAGER) |
| Authorized Official Contact | 7145786358 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1770 N. Wickham Rd Melbourne FL 32935 Ph: (321) 253-9792 | 1770 N. Wickham Rd Melbourne FL 32935 Ph: (321) 253-0606 |
| NPI Number | 1700958956 |
|---|---|
| Provider Enumeration Date | 11/14/2006 |
| Last Update Date | 12/16/2015 |
| Medicare PECOS PAC ID | 5597203372 |
|---|---|
| Medicare Enrollment ID | O20240812001169 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700958956 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 11747 (Florida) | Secondary |
| 1223G0001X | Dentist - General Practice | DN8678 (Florida) | Primary |
| Provider Name | Keum Hee Park |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1649331505 PECOS PAC ID: 1951615152 Enrollment ID: I20240812002686 |
Clark F. Brown, Jr. Dds, Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2113 Sarno Rd, Melbourne, FL 32935 Phone: 321-259-9429 Fax: 321-259-5844 | |
Eley Family Dentistry, P.a. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2301 W Eau Gallie Blvd, Suite #102, Melbourne, FL 32935 Phone: 321-622-8711 Fax: 321-622-8712 | |
Joe M Creel, Dds, Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 W New Haven Ave, Melbourne, FL 32901 Phone: 321-723-8821 | |
Sunshine Smiles Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 8061 Spyglass Hill Rd, Suite 101, Melbourne, FL 32940 Phone: 321-622-6255 Fax: 321-622-6254 | |
Stephen T. Ruso, D.d.s., M.s., P.l.l.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3760 N Wickham Rd Ste 1, Melbourne, FL 32935 Phone: 321-242-9900 | |
Aura Dental Family Practice Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3129 Pangea Cir, Melbourne, FL 32940 Phone: 347-485-3317 |