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Organization

VICTUS DENTAL II PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ANTHONY LE DMD (PRESIDENT)
(201) 375-3363
Entity
Organization

Contact information

Practice address
1308 WEST 9 MILE RD SUITE 9, PENSCOLA, FL 32534-3253
(850) 484-4844
Mailing address
2850 MONROE ST STE B, PENSACOLA, FL 32514-7656

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
025098900
FL
Enumeration date
02/09/2019
Last updated
09/06/2023
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