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Organization
UF
Active
Organization
UF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEE TAMMY (ADMINISTRATIVE SPECIALIST)
(352) 273-5688
Entity
Organization
Contact information
Practice address
1395 CENTER DR # D8-18, GAINESVILLE, FL 32610-0406
(352) 273-7755
Mailing address
1333 NW 117TH TER, GAINESVILLE, FL 32606-0422
(352) 226-4651
Taxonomy
Speciality
Code
Description
License number
State
1223X0008X
Oral and Maxillofacial Radiology Dentistry
Primary
—
NULL
1223X0008X
Oral and Maxillofacial Radiology Dentistry
Primary
—
—
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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