Organization
KIDS ONLY DENTAL PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT N MIXON D.M.D., P.A. (OWNER)
(352) 335-7777
Entity
Organization
Contact information
Practice address
5209 SW 91ST DR, GAINESVILLE, FL 32608-3028
(352) 335-7777
(352) 371-3430
Mailing address
5209 SW 91ST DR, GAINESVILLE, FL 32608-3028
(352) 335-7777
(352) 371-3430
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071755000
—
FL
01
—
36580
BCBS OF FL
FL
01
—
986885
UNITED CONCORDIA
FL
Enumeration date
07/31/2009
Last updated
07/31/2009
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