Organization
FOUR TOWNS DENTAL SERVICES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE GOMEZ (PROVIDER RELATIONS)
(305) 274-2499
Entity
Organization
Contact information
Practice address
2490 ENTERPRISE RD., ORANGE CITY, FL 32763
(386) 775-9575
(386) 775-9637
Mailing address
13195 SW 134 ST, 2ND FLOOR, MIAMI, FL 33186
(305) 274-2499
(305) 274-9312
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0300X
Periodontics
—
—
Other
Enumeration date
08/31/2006
Last updated
08/18/2014
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