Organization
GD FL FOREST PARK PLLC
Active
Other names
Forest Park Dental
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HENDRICKS (CREDENTIALING)
(612) 859-0444
Entity
Organization
Contact information
Practice address
2620 JENKS AVE, PANAMA CITY, FL 32405-4311
(850) 785-8586
Mailing address
2620 JENKS AVE, PANAMA CITY, FL 32405-4311
(850) 785-8586
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/17/2023
Last updated
03/17/2023
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