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Organization
PROFESSIONAL DENTAL ALLIANCE OF PRT ST LUCIE ST LUCIE, PLLC
Active
Organization
PROFESSIONAL DENTAL ALLIANCE OF PRT ST LUCIE ST LUCIE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA BARRETTE (CREDENTIALING SPECIALIST)
(724) 698-2997
Entity
Organization
Contact information
Practice address
1202 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5364
(772) 335-3088
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/23/2019
Last updated
05/23/2019
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