Organization
MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF ORANGE CITY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE GOMEZ (PROVIDER RELATIONS SPECIALIST)
(305) 274-2499
Entity
Organization
Contact information
Practice address
2435 S VOLUSIA AVE STE D2, ORANGE CITY, FL 32763-7643
(386) 775-0833
Mailing address
13195 SW 134TH ST FL 2, MIAMI, FL 33186-4461
(305) 274-2499
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
03/13/2012
Last updated
03/26/2015
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