352-Dentist, PA

Organization Active NPI Dental Clinic/Center · Lady Lake, FL

NPI 1487496337 · NPPES record last updated Jun 11, 2024

Key facts

NPI
1487496337
Entity type
Organization (NPI type 2)
Primary specialty
Dental Clinic/Center 261QD0000X
Legal business name
352-DENTIST, PA
Practice address
809 Highway 466 Ste C-102
Lady Lake, FL 32159-3909
Phone
(352) 336-8478
NPI assigned
Jun 11, 2024
Organization subpart
No

Authorized official

Name
Igor German, DMD
Title
Ceo
Phone
(352) 336-8478

Corporate family (same tax ID) 1

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

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Tax ID family
352-Dentist PA (2 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Yes

Addresses

Primary practice location

809 Highway 466 Ste C-102
Lady Lake, FL 32159-3909

Mailing address

13979 NW 30TH Ave
Gainesville, FL 32606-9311
Phone (352) 284-9045

Other names

  • Dental Discovery, PA Former legal business name

Other providers in Lady Lake, FL

All providers in Lady Lake, FL · Dental Clinic/Center in Florida

Sources for this page

Verify at the official NPI Registry.