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Organization
MIRROR IMAGE DENTISTRY
Active
Organization
MIRROR IMAGE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY RENEE NULTY D.M.D. (DENTIST)
(941) 929-9332
Entity
Organization
Contact information
Practice address
2140 BISPHAM RD, SARASOTA, FL 34231-5540
(941) 929-9332
(941) 929-7655
Mailing address
2140 BISPHAM RD, SARASOTA, FL 34231-5540
(941) 929-9332
(941) 929-7655
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN0014015
FL
Other
Enumeration date
07/22/2013
Last updated
07/22/2013
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