| |
7551 Osceola Polk Line Road Davenport FL 33896 | |
(863) 852-1195 | |
Not Available |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 7551 Osceola Polk Line Road, Davenport, Florida |
Authorized Official Name and Position | Carmen Woods (CREDENTIALING) |
Authorized Official Contact | 2175405100 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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7551 Osceola Polk Line Road Davenport FL 33896 Ph: () - | 7551 Osceola Polk Line Road Davenport FL 33896 Ph: (863) 852-1195 |
NPI Number | 1487020871 |
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Provider Enumeration Date | 08/19/2015 |
Last Update Date | 08/19/2015 |
Identifier | Type | State | Issuer |
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1487020871 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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