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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