Provider Demographics
NPI:1477952356
Name:DENTAL ASSOCIATES OF BROOKSVILLE
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF BROOKSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:BLEDSOE
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-796-2861
Mailing Address - Street 1:401 HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-2044
Mailing Address - Country:US
Mailing Address - Phone:352-796-3931
Mailing Address - Fax:352-796-2861
Practice Address - Street 1:401 HOWELL AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2044
Practice Address - Country:US
Practice Address - Phone:352-796-3931
Practice Address - Fax:352-796-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty