Organization
EAST LAKE DENTAL PLLC
Active
Other names
East Lake Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHACHY REEMA PHILIP DMD (OWNER)
(407) 346-4873
Entity
Organization
Contact information
Practice address
903 N. NARCOOSSEE RD, ST. CLOUD, FL 34771
(321) 236-1393
Mailing address
4352 SUMMER BREEZE WAY, KISSIMMEE, FL 34744-9603
(321) 236-1393
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/30/2019
Last updated
01/30/2019
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