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Organization
MCKISSOCK CORP.
Active
Organization
MCKISSOCK CORP.
Active
Other names
Windermere Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW DEAN MCKISSOCK D.M.D. (OWNER/PRESIDENT)
(407) 909-1099
Entity
Organization
Contact information
Practice address
4769 THE GROVE DR, SUITE 100, WINDERMERE, FL 34786-8421
(407) 909-1099
Mailing address
4769 THE GROVE DR, SUITE 100, WINDERMERE, FL 34786-8421
(407) 909-1099
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN14895
FL
Other
Enumeration date
07/23/2015
Last updated
08/11/2015
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