Provider Demographics
NPI:1417683707
Name:DOVER SHORES FAMILY PRACTICE
Entity Type:Organization
Organization Name:DOVER SHORES FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:KIVETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-275-9014
Mailing Address - Street 1:4711 CURRY FORD RD STE B
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-2704
Mailing Address - Country:US
Mailing Address - Phone:407-275-9014
Mailing Address - Fax:
Practice Address - Street 1:4711 CURRY FORD RD STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-2704
Practice Address - Country:US
Practice Address - Phone:407-275-9014
Practice Address - Fax:407-277-9249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty