Organization
BLUEWATER BAY DENTAL, PA
Active
Other names
Smileology
Organization subpart
No
Provider details
NPI number
Authorized official
OLIVIER BROUTIN (DIRECTOR)
(850) 897-4488
Entity
Organization
Contact information
Practice address
4400 E HIGHWAY 20 STE 101, NICEVILLE, FL 32578-9735
(850) 897-4488
Mailing address
4400 E HIGHWAY 20 STE 101, NICEVILLE, FL 32578-9735
(850) 897-4488
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN15111
FL
Other
Enumeration date
09/14/2015
Last updated
03/04/2022
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