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Organization
LAKE VIEW FAMILY DENTISTRY PA
Active
Organization
LAKE VIEW FAMILY DENTISTRY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN M DURETT DMD (PRESIDENT)
(727) 863-9669
Entity
Organization
Contact information
Practice address
13728 OFFICE PARK COURT, BAYONET POINT, FL 34667
(727) 863-9669
(727) 862-8907
Mailing address
13728 OFFICE PARK COURT, BAYONET POINT, FL 34667
(727) 863-9669
(727) 862-8907
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN14566
FL
1223G0001X
General Practice Dentistry
DN14685
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
539393
UNITED HEALTH CARE
FL
01
—
56988
BLUE CROSS BLUE SHIELD
FL
Enumeration date
09/16/2006
Last updated
08/22/2020
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