Provider Demographics
NPI:1992181978
Name:BILLINGS, DANTE
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:
Last Name:BILLINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 W LIME ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-4352
Mailing Address - Country:US
Mailing Address - Phone:863-370-5478
Mailing Address - Fax:
Practice Address - Street 1:1024 W LIME ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-4352
Practice Address - Country:US
Practice Address - Phone:863-370-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL595908Medicaid