| NPI | 1194199364 |
|---|---|
| Doing Business As | SPACE COAST DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | SHREE ANITHA PRASANNA Administrator Officer 321-268-0108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2015-11-25 |
| Last Update Date | 2025-03-28 |