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Organization

BRANDON FAMILY DENTAL CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DONNA L LICAUSE (OFFICE MANAGER)
(813) 685-5611
Entity
Organization

Contact information

Practice address
227 N KNIGHTS AVE, BRANDON, FL 33510-4390
(813) 685-5610
(813) 689-5904
Mailing address
227 N KNIGHTS AVE, BRANDON, FL 33510-4390
(813) 685-5610
(813) 689-5904

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
10/24/2019
Last updated
12/18/2019
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