Organization
ORBIT DENTAL MANAGEMENT PA
Active
Other names
St. Lucie West Dental Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
MIKHAIL GANKIN (OWNER)
(772) 348-4403
Entity
Organization
Contact information
Practice address
1453 NW SAINT LUCIE WEST BLVD, PORT ST LUCIE, FL 34986-1968
(772) 348-4403
(772) 348-4342
Mailing address
1453 NW SAINT LUCIE WEST BLVD, PORT ST LUCIE, FL 34986-1968
(772) 348-4403
(772) 348-4342
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Enumeration date
09/01/2020
Last updated
09/01/2020
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