Provider Demographics
NPI:1932781903
Name:DUNNELLON CENTER FOR COMPLETE DENTISTRY PA
Entity Type:Organization
Organization Name:DUNNELLON CENTER FOR COMPLETE DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-317-5528
Mailing Address - Street 1:11653 N WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-5890
Mailing Address - Country:US
Mailing Address - Phone:352-489-8433
Mailing Address - Fax:352-489-8477
Practice Address - Street 1:11653 N WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-5890
Practice Address - Country:US
Practice Address - Phone:352-489-8433
Practice Address - Fax:352-489-8477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental