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Organization
LAKE BUTLER DENTAL GROUP PA
Active
Organization
LAKE BUTLER DENTAL GROUP PA
Active
Other names
LAKE BUTLER DENTAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MINH PHAM DDS (OWNER)
(321) 248-2923
Entity
Organization
Contact information
Practice address
4014 WINTER GARDEN VINELAND ROAD, SUITE B, WINTER GARDEN, FL 34787
(321) 248-2923
(321) 418-8920
Mailing address
PO BOX 920050, DALLAS, TX 75392-0050
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/10/2023
Last updated
01/10/2023
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