Provider Demographics
NPI:1578953113
Name:DUNNELLON DENTISTRY
Entity Type:Organization
Organization Name:DUNNELLON DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTITST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GLUHAREFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-489-3922
Mailing Address - Street 1:11223 NORTH WILLIAMS STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432
Mailing Address - Country:US
Mailing Address - Phone:352-489-3922
Mailing Address - Fax:352-489-8462
Practice Address - Street 1:11223 NORTH WILLIAMS STREET
Practice Address - Street 2:SUITE C
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432
Practice Address - Country:US
Practice Address - Phone:352-489-3922
Practice Address - Fax:352-489-8462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN109131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty