Organization
SAND MINE DENTISTRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER KELLY (OWNER)
(407) 432-6224
Entity
Organization
Contact information
Practice address
49591 HIGHWAY 27 STE 301, DAVENPORT, FL 33897-9507
6
Mailing address
49591 HIGHWAY 27 STE 301, DAVENPORT, FL 33897-9507
6
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/05/2023
Last updated
06/05/2023
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