Organization
DYNAMIC PEDIATRIC DENTISTRY FOR CHILDREN,PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CINDY WILSON DDS (MMGR)
(772) 221-3112
Entity
Organization
Contact information
Practice address
3305 SE FEDERAL HWY, STUART, FL 34997-4913
(772) 221-3112
(772) 221-3175
Mailing address
3305 SE FEDERAL HWY, STUART, FL 34997-4913
(772) 221-3112
(772) 221-3175
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN17725
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
076508200
—
FL
Enumeration date
06/08/2010
Last updated
06/08/2010
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