Organization
DENTAL SPECIALISTS OF CENTRAL FLORIDA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN OUELLETTE (OWNER)
(321) 453-7750
Entity
Organization
Contact information
Practice address
455 MAGNOLIA AVE, MERRITT ISLAND, FL 32952-4838
(321) 453-7750
(321) 453-4966
Mailing address
455 MAGNOLIA AVE, MERRITT ISLAND, FL 32952-4838
(321) 453-7750
(321) 453-4966
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DN19069
FL
1223G0001X
General Practice Dentistry
Primary
DN19187
FL
124Q00000X
Dental Hygienist
DH17841
FL
Other
Enumeration date
10/15/2010
Last updated
10/15/2010
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