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Organization

DENTIST AT THE VILLAGES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CARLOS MEDINA DMD (OWNWE/DENTIST)
(352) 753-5789
Entity
Organization

Contact information

Practice address
307 LAGRANDE BLVD, LADY LAKE, FL 32159-2388
(352) 753-5789
Mailing address
307 LAGRANDE BLVD, LADY LAKE, FL 32159-2388
(352) 753-5789

Taxonomy

Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
DN 15845
FL

Other

Enumeration date
08/28/2016
Last updated
08/28/2016
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