Organization
SEACREST DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRED RUDER (OWNER)
(850) 231-3736
Entity
Organization
Contact information
Practice address
5399 E COUNTY HIGHWAY 30A, SANTA ROSA BEACH, FL 32459-6717
(850) 231-3736
Mailing address
5399 E COUNTY HIGHWAY 30A, SANTA ROSA BEACH, FL 32459-6717
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN 20813
FL
Other
Enumeration date
09/16/2014
Last updated
09/16/2014
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