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4620 S Florida Ave Ste 120 Lakeland FL 33813-2166 | |
| (863) 216-5765 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 4620 S Florida Ave Ste 120, Lakeland, Florida |
| Authorized Official Name and Position | Mary Mabry (OWNER DOCTOR) |
| Authorized Official Contact | 8632165765 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 920050 Dallas TX 75392-0050 Ph: (714) 845-8890 | 4620 S Florida Ave Ste 120 Lakeland FL 33813-2166 Ph: (863) 216-5765 |
| NPI Number | 1235649518 |
|---|---|
| Provider Enumeration Date | 10/02/2017 |
| Last Update Date | 06/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235649518 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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