Organization
FLORIDA DENTAL, PA
Active
Other names
Aspen Dental
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT CODWISE DICKERSON (OWNER/MANAGING CLINICAL DIRECTOR)
(866) 273-8204
Entity
Organization
Contact information
Practice address
4873 HIGHWAY 90 STE A, MILTON, FL 32571-1401
(850) 602-9033
(850) 995-4429
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(866) 273-8204
(866) 809-4943
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
16315
FL
Other
Enumeration date
05/06/2013
Last updated
05/06/2013
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