Provider Demographics
NPI:1477323798
Name:ARIETTA DENTAL PLLC
Entity Type:Organization
Organization Name:ARIETTA DENTAL PLLC
Other - Org Name:DREAM DENTAL WINTER HAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONDONO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:863-508-2565
Mailing Address - Street 1:526 SHALISA BLVD
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-9667
Mailing Address - Country:US
Mailing Address - Phone:407-721-6825
Mailing Address - Fax:
Practice Address - Street 1:1737 6TH ST NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-2301
Practice Address - Country:US
Practice Address - Phone:863-508-2565
Practice Address - Fax:863-508-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental