| Main Street Children's Dentistry Of Wellington | |
|
11903 Southern Blvd Suite 102 Royal Palm Beach FL 33411-7644 | |
| (561) 459-2733 | |
| Not Available |
| Full Name | Main Street Children's Dentistry Of Wellington |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 11903 Southern Blvd, Royal Palm Beach, Florida |
| Authorized Official Name and Position | Stephanie Gomez (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 3052742499 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Children's Dentistry Of Wellington 11903 Southern Blvd Suite 102 Royal Palm Beach FL 33411-7644 Ph: (561) 459-2733 | Main Street Children's Dentistry Of Wellington 11903 Southern Blvd Suite 102 Royal Palm Beach FL 33411-7644 Ph: (561) 459-2733 |
| NPI Number | 1275084345 |
|---|---|
| Provider Enumeration Date | 10/24/2016 |
| Last Update Date | 10/24/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275084345 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DN22345 (Florida) | Primary |
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