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715 Palm Bay Rd Ne Suite 107 West Melbourne FL 32904-9167 | |
| (321) 332-7375 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 715 Palm Bay Rd Ne, West Melbourne, Florida |
| Authorized Official Name and Position | Kendra Walker (CREDENTIALING TEAM LEAD) |
| Authorized Official Contact | 2175408312 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
715 Palm Bay Rd Ne Suite 107 West Melbourne FL 32904-9167 Ph: (321) 327-2427 | 715 Palm Bay Rd Ne Suite 107 West Melbourne FL 32904-9167 Ph: (321) 332-7375 |
| NPI Number | 1285080929 |
|---|---|
| Provider Enumeration Date | 05/12/2016 |
| Last Update Date | 11/08/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285080929 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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