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Organization
MDM OF LAKELAND PA
Active
Organization
MDM OF LAKELAND PA
Active
Other names
Highlands Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY A MARTIN (PRESIDENT)
(863) 709-1903
Entity
Organization
Contact information
Practice address
2153 E COUNTY ROAD 540A, LAKELAND, FL 33813-3794
(863) 709-1903
(863) 709-8833
Mailing address
701 S HOWARD AVE STE 106-386, TAMPA, FL 33606-2473
(863) 709-1903
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN18829
FL
Other
Enumeration date
01/17/2012
Last updated
01/17/2012
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