Provider Demographics
NPI:1326472184
Name:HIBISCUS DENTAL
Entity Type:Organization
Organization Name:HIBISCUS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SWETA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-777-4733
Mailing Address - Street 1:446 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4822
Mailing Address - Country:US
Mailing Address - Phone:321-449-9300
Mailing Address - Fax:321-449-9338
Practice Address - Street 1:446 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4822
Practice Address - Country:US
Practice Address - Phone:321-449-9300
Practice Address - Fax:321-449-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty