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Organization
KISSIMMEE MODERN DENTISTRY, PA
Active
Organization
KISSIMMEE MODERN DENTISTRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROOKE KOVINSKY (OWNER)
(714) 845-8500
Entity
Organization
Contact information
Practice address
4396 W VINE ST, KISSIMMEE, FL 34746
(407) 232-6187
Mailing address
PO BOX 660041, DALLAS, TX 75266-0041
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/20/2025
Last updated
05/13/2026
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