Organization
DEBARY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER KELLY (OWNER)
(410) 303-1528
Entity
Organization
Contact information
Practice address
190 N CHARLES RICHARD BEALL BLVD STE 101, DEBARY, FL 32713-2271
(386) 668-2003
Mailing address
190 N CHARLES RICHARD BEALL BLVD STE 101, DEBARY, FL 32713-2271
(386) 668-2003
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN19430
STATE LICENSE
FL
Enumeration date
03/17/2020
Last updated
03/17/2020
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