# LAFAYETTE COUNTY HEALTH DEPARTMENT-DENTAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447268354
- **Authorized official:** MRS. SANDRA KIM PEPPER (BUSINESS MANAGER)
- **Authorized official phone:** (386) 362-2708

## Contact information

- **Practice address:** 140 SW VIRGINIA CIR, MAYO, FL 32066-4064
- **Practice address phone:** (386) 294-2012
- **Practice address fax:** (386) 294-3457
- **Mailing address:** PO BOX 1806, MAYO, FL 32066-1806
- **Mailing address phone:** (386) 294-1321
- **Mailing address fax:** (386) 294-3457

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251K00000X | Public Health or Welfare Agency | DN 14318 | FL | Yes |

## Other

- **Enumeration date:** 08/04/2006
- **Last updated:** 08/22/2020