Organization
AQUIDEL DENTAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYRENE MYRENE (BILLING STAFF)
(516) 596-8123
Entity
Organization
Contact information
Practice address
11574 SW VILLAGE PKWY, PORT ST LUCIE, FL 34987-2392
(772) 204-3113
Mailing address
11574 SW VILLAGE PKWY, PORT ST LUCIE, FL 34987-2392
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/06/2022
Last updated
08/06/2022
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