| Midtown Dental Center Llc | |
|
3011 Central Ave St Petersburg FL 33713-8632 | |
| (727) 322-1828 | |
| Not Available |
| Full Name | Midtown Dental Center Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3011 Central Ave, St Petersburg, Florida |
| Authorized Official Name and Position | Jacqueline Nelson-mangatal (DENTIST) |
| Authorized Official Contact | 7863165044 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Midtown Dental Center Llc Po Box 12197 St Petersburg FL 33733-2197 Ph: () - | Midtown Dental Center Llc 3011 Central Ave St Petersburg FL 33713-8632 Ph: (727) 322-1828 |
| NPI Number | 1992078521 |
|---|---|
| Provider Enumeration Date | 02/13/2012 |
| Last Update Date | 02/13/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992078521 | NPI | - | NPPES |
| 075681400 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN16582 (Florida) | Primary |
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