| Winter Haven Oral Surgery, Pa | |
|
400 Avenue K Se Suite # 14a Winter Haven FL 33880-4146 | |
| (863) 294-7648 | |
| (863) 294-9045 |
| Full Name | Winter Haven Oral Surgery, Pa |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 400 Avenue K Se, Winter Haven, Florida |
| Authorized Official Name and Position | Jose Luis Leon Ramirez (VICE PRESIDENT) |
| Authorized Official Contact | 8632947648 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Winter Haven Oral Surgery, Pa 400 Avenue K Se Suite # 14a Winter Haven FL 33880-4146 Ph: (863) 294-7648 | Winter Haven Oral Surgery, Pa 400 Avenue K Se Suite # 14a Winter Haven FL 33880-4146 Ph: (863) 294-7648 |
| NPI Number | 1609122357 |
|---|---|
| Provider Enumeration Date | 07/31/2012 |
| Last Update Date | 08/21/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609122357 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DN18539 (Florida) | Primary |
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