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Organization

ELLENTON FAMILY DENTAL CORP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CARLA M MATHEWS (OFFICE MANAGER)
(941) 479-7936
Entity
Organization

Contact information

Practice address
5975 FACTORY SHOPS BLVD, ELLENTON, FL 34222-4125
(941) 479-7936
(941) 479-7991
Mailing address
5975 FACTORY SHOPS BLVD, ELLENTON, FL 34222-4125
(941) 479-7936
(941) 479-7991

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Enumeration date
09/14/2015
Last updated
09/14/2015
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