Organization
COUNTRY CLUB DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES W WARDNER D.M.D. (DENTIST)
(321) 269-1242
Entity
Organization
Contact information
Practice address
214 COUNTRY CLUB DR, TITUSVILLE, FL 32780-8605
(321) 269-1242
(321) 269-4477
Mailing address
214 COUNTRY CLUB DR, TITUSVILLE, FL 32780-8605
(321) 269-1242
(321) 269-4477
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11533
FL
122300000X
Dentist
9681
FL
Other
Enumeration date
11/06/2009
Last updated
11/06/2009
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