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1339 N Sumter Blvd North Port FL 34286-8072 | |
| (941) 888-1005 | |
| (941) 888-1004 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1339 N Sumter Blvd, North Port, Florida |
| Authorized Official Name and Position | Belinda Huerta (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175402100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1339 N Sumter Blvd North Port FL 34286-8072 Ph: (941) 888-1005 | 1339 N Sumter Blvd North Port FL 34286-8072 Ph: (941) 888-1005 |
| NPI Number | 1275216681 |
|---|---|
| Provider Enumeration Date | 08/11/2023 |
| Last Update Date | 08/11/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275216681 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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