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1405 S 25th St Ste B Fort Pierce FL 34947-4700 | |
| (772) 465-4545 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1405 S 25th St, Fort Pierce, Florida |
| Authorized Official Name and Position | Cassandra Teutsch (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175408972 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1405 S 25th St Ste B Fort Pierce FL 34947-4700 Ph: (772) 465-4545 | 1405 S 25th St Ste B Fort Pierce FL 34947-4700 Ph: (772) 465-4545 |
| NPI Number | 1144763053 |
|---|---|
| Provider Enumeration Date | 11/25/2016 |
| Last Update Date | 11/25/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144763053 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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