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4579 E Highway 20 Ste 210 Niceville FL 32578-9810 | |
(850) 897-4200 | |
Not Available |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 4579 E Highway 20 Ste 210, Niceville, Florida |
Authorized Official Name and Position | Faith Gaskins (DIRECTOR OF CREDENTIALING) |
Authorized Official Contact | 9728693789 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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4579 E Highway 20 Ste 210 Niceville FL 32578-9810 Ph: (850) 897-4200 | 4579 E Highway 20 Ste 210 Niceville FL 32578-9810 Ph: (850) 897-4200 |
NPI Number | 1528427739 |
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Provider Enumeration Date | 02/16/2016 |
Last Update Date | 02/04/2022 |
Identifier | Type | State | Issuer |
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1528427739 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | DN20656 (Florida) | Primary |
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