Organization
ADVANCED ORTHODONTICS OF AMERICA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN KOVALESKI (MANAGER)
(850) 769-2722
Entity
Organization
Contact information
Practice address
2202 STATE AVE STE 200, PANAMA CITY, FL 32405-4582
(850) 769-2722
Mailing address
2202 STATE AVE STE 200, PANAMA CITY, FL 32405-4582
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN19214
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007329900
—
FL
Enumeration date
11/23/2016
Last updated
11/23/2016
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