| Pediatric Dental Center | |
|
517 Corner Drive Brandon FL 33511-5718 | |
| (813) 685-0804 | |
| (813) 681-7213 |
| Full Name | Pediatric Dental Center |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 517 Corner Drive, Brandon, Florida |
| Authorized Official Name and Position | William Edward Gonzalez (PRESIDENT) |
| Authorized Official Contact | 8136850804 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dental Center 517 Corner Drive Brandon FL 33511-5718 Ph: (813) 685-0804 | Pediatric Dental Center 517 Corner Drive Brandon FL 33511-5718 Ph: (813) 685-0804 |
| NPI Number | 1710244702 |
|---|---|
| Provider Enumeration Date | 04/16/2012 |
| Last Update Date | 04/16/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710244702 | NPI | - | NPPES |
| 074133700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DN6377 (Florida) | Primary |
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