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Organization
MY FAVORITE DENTAL BOUTIQUE LLC
Active
Organization
MY FAVORITE DENTAL BOUTIQUE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA GRISALES CANO (OWNER)
(407) 274-4744
Entity
Organization
Contact information
Practice address
1670 S US HIGHWAY 17 92, LONGWOOD, FL 32750-6516
(407) 274-4744
Mailing address
1670 S US HIGHWAY 17 92, LONGWOOD, FL 32750-6516
(407) 274-4744
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/27/2024
Last updated
03/27/2024
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