Individual
HY T LE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1475 6TH ST NW, WINTER HAVEN, FL 33881-2365
(973) 328-9100
Mailing address
4525 BRITTANY HEYWORTH WAY APT 205, LAKELAND, FL 33813-3178
(609) 742-7601
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DN25716
FL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN25716
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2020
Last updated
08/14/2023
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