| Panama City Beach Center For Cosmetic & Family Destistry | |
|
309 N Richard Jackson Blvd Panama City Beach FL 32407-3695 | |
| (850) 235-2299 | |
| (850) 334-9017 |
| Full Name | Panama City Beach Center For Cosmetic & Family Destistry |
|---|---|
| Speciality | Dentist |
| Location | 309 N Richard Jackson Blvd, Panama City Beach, Florida |
| Authorized Official Name and Position | Dennis W Lichorwic (OWNER/ PRESIDENT) |
| Authorized Official Contact | 8506548665 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Panama City Beach Center For Cosmetic & Family Destistry 4635 Gulfstarr Dr Destin FL 32541-5780 Ph: (850) 654-8665 | Panama City Beach Center For Cosmetic & Family Destistry 309 N Richard Jackson Blvd Panama City Beach FL 32407-3695 Ph: (850) 235-2299 |
| NPI Number | 1275951717 |
|---|---|
| Provider Enumeration Date | 04/02/2014 |
| Last Update Date | 04/02/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275951717 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 0014608 (Florida) | Primary |
| 122300000X | Dentist | DN19333 (Florida) | Secondary |
| 122300000X | Dentist | DN19829 (Florida) | Secondary |
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