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Organization
MIDTOWN DENTAL CENTER LLC
Active
Organization
MIDTOWN DENTAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE NELSON-MANGATAL DDS (DENTIST)
(786) 316-5044
Entity
Organization
Contact information
Practice address
3011 CENTRAL AVE, ST PETERSBURG, FL 33713-8632
(727) 322-1828
Mailing address
PO BOX 12197, ST PETERSBURG, FL 33733-2197
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN16582
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
075681400
—
FL
Enumeration date
02/13/2012
Last updated
02/13/2012
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