Individual
DR. DERRY GUSHEN AGNINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
39863 HIGHWAY 27, DAVENPORT, FL 33837-7802
(863) 353-6867
Mailing address
417 NORTH RD, LAKELAND, FL 33809-2225
(863) 513-8112
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN 16647
FL
Other
Enumeration date
10/22/2009
Last updated
02/25/2010
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