Organization
INTERNATIONAL CENTER FOR COMPLETE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DREAMA MICHELLE WEGZYN (RN, OFFICE MANAGER)
(727) 821-4433
Entity
Organization
Contact information
Practice address
111 2ND AVE NE, #1104, SAINT PETERSBURG, FL 33701-3434
(727) 821-4433
(727) 822-7252
Mailing address
111 2ND AVE NE, #1104, SAINT PETERSBURG, FL 33701-3434
(727) 821-4433
(727) 822-7252
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
DN4596
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1154643377
NPI
FL
01
—
1295851293
NPI
FL
01
—
1477679470
NPI
FL
01
—
1679692461
NPI
FL
01
—
1770602567
NPI
FL
01
—
1952426439
NPI
FL
01
—
6301580001
PTAN
FL
Enumeration date
02/16/2010
Last updated
06/23/2010
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