Organization
MEDICAL HOLISTIC CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATIE ANNE STEVENSON DOM (MANAGING PARTNER)
(386) 663-3003
Entity
Organization
Contact information
Practice address
512 CANAL ST, NEW SMYRNA BEACH, FL 32168-7012
(386) 663-3003
(386) 663-3007
Mailing address
512 CANAL ST, NEW SMYRNA BEACH, FL 32168-7012
(386) 663-3003
(386) 663-3007
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
OS9438
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
279979100
MEDIPASS
FL
05
—
279979100
—
FL
Enumeration date
07/16/2008
Last updated
07/16/2008
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