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Organization
PROFESSIONAL DENTAL ALLIANCE OF ST CLOUD - KISSIMMEE, PLLC
Active
Organization
PROFESSIONAL DENTAL ALLIANCE OF ST CLOUD - KISSIMMEE, PLLC
Active
Other names
New Image Dentistry St Cloud-Kissimmee
Organization subpart
No
Provider details
NPI number
Authorized official
ANNETTTE MARLOW (CREDENTIALING SUPERVISOR)
(724) 698-2119
Entity
Organization
Contact information
Practice address
3101 13TH ST, SAINT CLOUD, FL 34769-5925
(407) 957-2000
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/13/2018
Last updated
08/13/2018
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