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Organization
ALTAMONTE SPRINGS DENTAL, PLLC
Active
Organization
ALTAMONTE SPRINGS DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER KELLY (OWNER)
(410) 303-1528
Entity
Organization
Contact information
Practice address
499 E CENTRAL PKWY STE 200, ALTAMONTE SPRINGS, FL 32701-3450
(407) 831-3959
Mailing address
499 E CENTRAL PKWY STE 200, ALTAMONTE SPRINGS, FL 32701-3450
(407) 831-3959
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN12540
STATE LICENSE
FL
01
—
DN19430
STATE LICENSE
FL
01
—
DN23428
STATE LICENSE
FL
Enumeration date
03/19/2020
Last updated
03/19/2020
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