Organization
FLORIDA FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANUEL IGNACIO CRUCES DDS (DENTIST, DIRECTOR)
(772) 380-0920
Entity
Organization
Contact information
Practice address
10624 S FEDERAL HWY, PORT ST LUCIE, FL 34952-6401
(772) 380-0920
(772) 380-0921
Mailing address
10624 S FEDERAL HWY, PORT ST LUCIE, FL 34952-6401
(772) 380-0920
(772) 380-0921
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN18716
FL
Other
Enumeration date
10/31/2013
Last updated
10/31/2013
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