| |
1670 S Hwy 17 92 Longwood FL 32750-6516 | |
(407) 339-4700 | |
(407) 339-7736 |
Full Name | |
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Speciality | Dentist |
Location | 1670 S Hwy 17 92, Longwood, Florida |
Authorized Official Name and Position | Prem K Kathuria (DENTIST) |
Authorized Official Contact | 4073394700 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1670 S Hwy 17 92 Longwood FL 32750-6516 Ph: (407) 339-4700 | 1670 S Hwy 17 92 Longwood FL 32750-6516 Ph: (407) 339-4700 |
NPI Number | 1922449214 |
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Provider Enumeration Date | 07/15/2013 |
Last Update Date | 07/15/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922449214 | NPI | - | NPPES |
074725400 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | DN8196 (Florida) | Primary |
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