| Your Downtown Dentistry | |
|
945 State Road 436 Casselberry FL 32707-5662 | |
| (407) 831-4077 | |
| Not Available |
| Full Name | Your Downtown Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 945 State Road 436, Casselberry, Florida |
| Authorized Official Name and Position | Andrea Villavicencio (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 4078314077 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Your Downtown Dentistry 945 State Road 436 Casselberry FL 32707-5662 Ph: (407) 831-4077 | Your Downtown Dentistry 945 State Road 436 Casselberry FL 32707-5662 Ph: (407) 831-4077 |
| NPI Number | 1932654035 |
|---|---|
| Provider Enumeration Date | 08/18/2016 |
| Last Update Date | 08/23/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932654035 | NPI | - | NPPES |
| 002483500 | Medicaid | FL | |
| 002483900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN15536 (Florida) | Primary |
| 1223G0001X | Dentist - General Practice | DN19047 (Florida) | Secondary |
Ali Behzadi D.m.d P.a Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 945 State Road 436, Casselberry, FL 32707 Phone: 407-831-4077 Fax: 407-831-8077 | |
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