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Organization
PROFESSIONAL DENTAL ALLIANCE OF COUNTRY WALK, PLLC
Active
Organization
PROFESSIONAL DENTAL ALLIANCE OF COUNTRY WALK, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN HOWARD (CREDENTIALING)
(757) 576-5479
Entity
Organization
Contact information
Practice address
15795 SW 152ND ST, MIAMI, FL 33187-5417
(305) 547-8390
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/23/2019
Last updated
08/23/2019
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