| NPI | 1174850093 |
|---|---|
| Doing Business As | MAIN STREET CHILDREN'S DENISTRY OF PALMETTO BAY |
| Entity Type | Organization |
| Authorized Contact | STEPHANIE GOMEZ Credentialing Supervisor 305-274-2499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2022-07-21 |