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Organization
MIDBAY DENTAL PPLC
Active
Organization
MIDBAY DENTAL PPLC
Active
Other names
Mid Bay Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTINE KONANE CHASE DDS (OWNER)
(850) 897-4200
Entity
Organization
Contact information
Practice address
4579 E HIGHWAY 20 STE 210, NICEVILLE, FL 32578-9810
(850) 897-4200
(850) 897-4504
Mailing address
4579 E HIGHWAY 20 STE 210, NICEVILLE, FL 32578-9810
(850) 897-4200
(850) 897-4504
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN14797
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841210267
INDIVIDUAL
FL
Enumeration date
02/16/2016
Last updated
02/04/2022
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