Provider Demographics
NPI:1871662080
Name:SATELLITE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SATELLITE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHERY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-773-7551
Mailing Address - Street 1:210 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937
Mailing Address - Country:US
Mailing Address - Phone:321-773-7551
Mailing Address - Fax:321-773-4292
Practice Address - Street 1:210 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937
Practice Address - Country:US
Practice Address - Phone:321-773-7551
Practice Address - Fax:321-773-4292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL87811223G0001X
1223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty