NPIMap

Advantage Dental Oral Health Center of Florida PA

Organization Active NPI General Practice Dentistry · Crestview, FL

NPI 1285375873 · NPPES record last updated Aug 3, 2022

Key facts

NPI
1285375873
Entity type
Organization (NPI type 2)
Primary specialty
General Practice Dentistry 1223G0001X
Legal business name
ADVANTAGE DENTAL ORAL HEALTH CENTER OF FLORIDA PA
Practice address
775 N Ferdon Blvd Ste a
Crestview, FL 32536-2167
Phone
(850) 220-1120
NPI assigned
Apr 6, 2022
Organization subpart
No

Authorized official

Name
Sherrie Edmondson
Title
Manager, Licensing & Certification
Phone
(629) 999-5014

Corporate family (same tax ID) 6

Organizations that report the same tax identification number in the National Provider Directory.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2275695Advantage Dental Oral Health Center of FL PA
775 N Ferdon Blvd, Crestview, FL 32536		Certificate of waiverJan 25, 2027

National Provider Directory

Tax ID family
Advantage Dental Oral Health Center of Florida PA (7 organizations share this tax ID)

Locations

751 N Ferdon Blvd
#778
Crestview, FL 32536

775 N Ferdon Blvd
Ste A
Crestview, FL 32536
Phone (850) 220-1120

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 122300000X
General Practice Dentistry
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 1223G0001X Yes

Addresses

Primary practice location

775 N Ferdon Blvd Ste a
Crestview, FL 32536-2167

Mailing address

3322 W End Ave Ste 400
Nashville, TN 37203-6805
Phone (629) 999-5014

Other providers in Crestview, FL

All providers in Crestview, FL · General Practice Dentistry in Florida

Sources for this page

Verify at the official NPI Registry.