Provider Demographics
NPI:1073875480
Name:OCEAN BREEZE DENTAL, PA
Entity Type:Organization
Organization Name:OCEAN BREEZE DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KALIMNIOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-433-1141
Mailing Address - Street 1:817 WESTPORT DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3501
Mailing Address - Country:US
Mailing Address - Phone:321-433-1141
Mailing Address - Fax:321-433-1210
Practice Address - Street 1:817 WESTPORT DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3501
Practice Address - Country:US
Practice Address - Phone:321-433-1141
Practice Address - Fax:321-433-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15187122300000X
FLDN19254122300000X
FLDN19217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty