Individual
DR. SERENA GHODASRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
5710 US HIGHWAY 98 N, LAKELAND, FL 33809-3108
(863) 640-2150
Mailing address
411 MIRRORTON AVE UNIT 217, LAKELAND, FL 33801-4995
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN25391
FL
390200000X
Student in an Organized Health Care Education/Training Program
DRP2237
FL
Other
Enumeration date
08/13/2020
Last updated
04/25/2023
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