Organization
KEY WEST DENTAL MANAGEMENT GROUP LLC
Active
Other names
Key West Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ISIS SAMPEDRO (C.O.O)
(786) 226-7474
Entity
Organization
Contact information
Practice address
1215 SIMONTON ST, KEY WEST, FL 33040-3158
(305) 296-8541
Mailing address
1215 SIMONTON ST, KEY WEST, FL 33040-3158
(305) 296-8541
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024079200
—
FL
Enumeration date
09/21/2021
Last updated
09/21/2021
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