Organization
CHURCHILL PEDIATRIC DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REBECCA J TARVER DMD (OWNER)
(352) 274-9731
Entity
Organization
Contact information
Practice address
1371 SW 43RD PL, OCALA, FL 34471-7501
(352) 274-9731
Mailing address
1371 SW 43RD PL, OCALA, FL 34471-7501
(352) 274-9731
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN19038
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002880200
—
FL
Enumeration date
10/08/2013
Last updated
10/08/2013
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