| Port Orange Modern Dentistry | |
|
1765 Dunlawton Ave. Suite 103 Port Orange FL 32129 | |
| (386) 259-3905 | |
| (386) 259-3905 |
| Full Name | Port Orange Modern Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 1765 Dunlawton Ave., Port Orange, Florida |
| Authorized Official Name and Position | Minh B Pham (OWNER/GP) |
| Authorized Official Contact | 3862593905 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Port Orange Modern Dentistry Po Box 920050 Dallas TX 75392-0050 Ph: (714) 845-8890 | Port Orange Modern Dentistry 1765 Dunlawton Ave. Suite 103 Port Orange FL 32129 Ph: (386) 259-3905 |
| NPI Number | 1982179818 |
|---|---|
| Provider Enumeration Date | 10/08/2018 |
| Last Update Date | 08/25/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982179818 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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