# DENNIS LICHORWIC DMD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679990501
- **Authorized official:** DR. DENNIS WAYNE LICHORWIC DMD (OWNER/PRESIDENT)
- **Authorized official phone:** (850) 654-8665

## Contact information

- **Practice address:** 4635 GULFSTARR DR, DESTIN, FL 32541-5780
- **Practice address phone:** (850) 654-8665
- **Practice address fax:** (850) 654-9584
- **Mailing address:** 4635 GULFSTARR DR, DESTIN, FL 32541-5780
- **Mailing address phone:** (850) 654-8665
- **Mailing address fax:** (850) 654-9584

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0014608 | FL | Yes |
| 122300000X | Dentist | DN19333 | FL | — |
| 122300000X | Dentist | DN19829 | FL | — |

## Other

- **Enumeration date:** 03/28/2014
- **Last updated:** 03/28/2014