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606 W Magnolia St Leesburg FL 34748-5892 | |
| (352) 787-4800 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 606 W Magnolia St, Leesburg, Florida |
| Authorized Official Name and Position | Stephen W George (MANAGER) |
| Authorized Official Contact | 3527874800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
606 W Magnolia St Leesburg FL 34748-5892 Ph: (352) 787-4800 | 606 W Magnolia St Leesburg FL 34748-5892 Ph: (352) 787-4800 |
| NPI Number | 1972174720 |
|---|---|
| Provider Enumeration Date | 07/02/2021 |
| Last Update Date | 07/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972174720 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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