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Organization

MEDICAID DENTISTRY OF DAYTONA LLC

Active
Other names
Daytona Pediatric Dentistry
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MUBASHIR CHAUDHRY DMD (OWNER)
(386) 304-2677
Entity
Organization

Contact information

Practice address
1021 SOUTH RIDGEWOOD AVE, DAYTONA BEACH, FL 32114
(386) 304-2677
(386) 304-1899
Mailing address
1021 SOUTH RIDGEWOOD AVE, DAYTONA BEACH, FL 32114
(386) 304-2677
(386) 304-1899

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
FL
1223P0221X
Pediatric Dentistry
Primary
DN13783
FL
1223P0221X
Pediatric Dentistry
DN18742
FL

Other

Enumeration date
07/31/2013
Last updated
05/21/2018
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