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Organization

MAIN STREET CHILDREN'S DENTISTRY OF WELLINGTON

Active
Organization subpart
No

Provider details

NPI number
Authorized official
STEPHANIE GOMEZ (CREDENTIALING COORDINATOR)
(305) 274-2499
Entity
Organization

Contact information

Practice address
11903 SOUTHERN BLVD, SUITE 102, ROYAL PALM BEACH, FL 33411-7644
(561) 459-2733
Mailing address
11903 SOUTHERN BLVD, SUITE 102, ROYAL PALM BEACH, FL 33411-7644
(561) 459-2733

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN22345
FL

Other

Enumeration date
10/24/2016
Last updated
10/24/2016
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