Organization
COUNRTYSIDE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBRA L GONZALEZ (OFFICE MANAGER)
(727) 669-2887
Entity
Organization
Contact information
Practice address
2165 PALMETTO STREET, CLEARWATER, FL 33765
(727) 669-2887
(727) 669-9103
Mailing address
2165 PALMETTO STREET, CLEARWATER, FL 33765
(727) 669-2887
(727) 669-9103
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/06/2006
Last updated
09/27/2011
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