Organization
LAKE BUTLER DENTAL GROUP PA
Active
Other names
LAKE BUTLER DENTAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MINH PHAM DDS (OWNER)
(321) 248-2923
Entity
Organization
Contact information
Practice address
4014 WINTER GARDEN VINELAND ROAD, SUITE B, WINTER GARDEN, FL 34787
(321) 248-2923
(321) 418-8920
Mailing address
PO BOX 920050, DALLAS, TX 75392-0050
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/10/2023
Last updated
01/10/2023
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