Organization
SOUTHSHORE ORTHODONTICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW AHRENS (PRESIDENT)
(352) 843-0783
Entity
Organization
Contact information
Practice address
13135 KINGS LAKE DR # 103, GIBSONTON, FL 33534-3960
(813) 815-0080
Mailing address
13135 KINGS LAKE DR # 103, GIBSONTON, FL 33534-3960
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
18985
FL
Other
Enumeration date
01/12/2015
Last updated
01/13/2015
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