Individual
GYNNEKIA MARIE BOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4873 BELLE TERRE PKWY, PALM COAST, FL 32137-8696
(386) 864-8313
Mailing address
12700 BARTRAM PARK BLVD APT 2314, JACKSONVILLE, FL 32258-5449
(813) 420-7929
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN25483
FL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/10/2020
Last updated
09/23/2020
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