Organization
DESTINATION DENTAL GROUP PC
Active
Other names
Destination Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DAN KELSEY (CFO)
(616) 299-2692
Entity
Organization
Contact information
Practice address
2455 E SUNRISE BLVD STE 1204, FORT LAUDERDALE, FL 33304-3115
(616) 299-2692
Mailing address
2455 E SUNRISE BLVD STE 1204, FORT LAUDERDALE, FL 33304-3115
(616) 299-2692
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/22/2025
Last updated
01/22/2025
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