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255 Sw Main Blvd Lake City FL 32025-7050 | |
| (386) 752-2480 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 255 Sw Main Blvd, Lake City, Florida |
| Authorized Official Name and Position | Johann Ramkissoon (OWNER) |
| Authorized Official Contact | 3867522480 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
255 Sw Main Blvd Lake City FL 32025-7050 Ph: (386) 752-2480 | 255 Sw Main Blvd Lake City FL 32025-7050 Ph: (386) 752-2480 |
| NPI Number | 1710497862 |
|---|---|
| Provider Enumeration Date | 10/03/2017 |
| Last Update Date | 05/03/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710497862 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 1223G0001X | Dentist - General Practice | 21272 (Florida) | Secondary |
Gregory N Borganelli Dmd Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 875 Sw State Rd 47, Lake City, FL 32025 Phone: 386-752-8200 Fax: 386-752-8209 | |
Melanie Holden, Dmd, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 255 Sw Main Blvd, Lake City, FL 32025 Phone: 386-752-2480 | |
David F Randolph Dmd Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1779 Sw Barnett Way Ste 101, Lake City, FL 32025 Phone: 386-755-4033 Fax: 386-755-2581 |