Organization
MY DENTIST OF PORT ST. LUCIE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN TOMALTY D.M.D (OWNER)
(561) 633-9676
Entity
Organization
Contact information
Practice address
1455 SW GATLIN BLVD, PORT ST. LUCIE, FL 34953
(561) 801-4233
Mailing address
1455 SW GATLIN BLVD, PORT ST. LUCIE, FL 34953
(561) 801-4233
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/05/2023
Last updated
09/05/2023
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