Individual
CARLOTTA FANTIN-YUSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4646 JOHN R ST, DETROIT, MI 48201-1916
(313) 576-1000
Mailing address
13803 NW 21ST LN, GAINESVILLE, FL 32606-5348
(248) 981-8634
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
24041
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/14/2018
Last updated
12/03/2019
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