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Organization
VDC-CRYSTAL RIVER PA
Active
Organization
VDC-CRYSTAL RIVER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANEEN M GORMAN (MANGER)
(352) 684-1274
Entity
Organization
Contact information
Practice address
6824 W GULF TO LAKE HWY, CRYSTAL RIVER, FL 34429-7806
(352) 684-1274
(352) 263-2756
Mailing address
6824 W GULF TO LAKE HWY, CRYSTAL RIVER, FL 34429-7806
(352) 684-1274
(352) 263-2756
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DN17081
FL
1223G0001X
General Practice Dentistry
DN17567
FL
1223G0001X
General Practice Dentistry
Primary
DN7162
FL
Other
Enumeration date
01/27/2012
Last updated
02/16/2012
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