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3207 S Florida Ave Lakeland FL 33803-4550 | |
| (863) 937-9181 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 3207 S Florida Ave, Lakeland, Florida |
| Authorized Official Name and Position | Kendra Walker (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175408312 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3207 S Florida Ave Lakeland FL 33803-4550 Ph: (863) 937-9181 | 3207 S Florida Ave Lakeland FL 33803-4550 Ph: (863) 937-9181 |
| NPI Number | 1649668682 |
|---|---|
| Provider Enumeration Date | 12/29/2014 |
| Last Update Date | 12/29/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649668682 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | DN19410 (Florida) | Primary |
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