Organization
BOULDER ROCK DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA WHITAKER (OFFICE MANAGER)
(386) 276-9051
Entity
Organization
Contact information
Practice address
5 BOULDER ROCK DR STE A, PALM COAST, FL 32137-8538
(386) 931-1685
Mailing address
5 BOULDER ROCK DR STE A, PALM COAST, FL 32137-8538
(386) 276-9051
(386) 276-9053
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN15016
FL
Other
Enumeration date
01/08/2018
Last updated
06/12/2024
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