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Organization
MID BAY DENTAL PLLC
Active
Organization
MID BAY DENTAL PLLC
Active
Other names
Mid Bay Dental
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH GASKINS (DIRECTOR OF CREDENTIALING)
(972) 869-3789
Entity
Organization
Contact information
Practice address
4579 E HIGHWAY 20 STE 210, NICEVILLE, FL 32578-9810
(850) 897-4200
Mailing address
4579 E HIGHWAY 20 STE 210, NICEVILLE, FL 32578-9810
(850) 897-4200
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN20656
FL
Other
Enumeration date
02/16/2016
Last updated
02/04/2022
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