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Organization
PARK AVENUE DENTAL
Active
Organization
PARK AVENUE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE NELIS GOSLINGA DMD (OWNER)
(352) 331-7573
Entity
Organization
Contact information
Practice address
912 NW 56TH TER STE B, GAINESVILLE, FL 32605-6404
(352) 331-7573
Mailing address
912 NW 56TH TER STE B, GAINESVILLE, FL 32605-6404
(352) 331-7573
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17071
FL
Other
Enumeration date
07/18/2008
Last updated
07/18/2008
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