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Organization
PROFESSIONAL DENTAL ALLIANCE OF PALM BAY, PLLC
Active
Organization
PROFESSIONAL DENTAL ALLIANCE OF PALM BAY, PLLC
Active
Other names
Palm Bay Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
ANNETTE MARLOW (CREDENTIALING SUPERVISOR)
(321) 725-5512
Entity
Organization
Contact information
Practice address
1764 PALM BAY RD NE, PALM BAY, FL 32905-2904
(321) 725-5512
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
(724) 698-2132
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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