Ellenton Family Dental Corp

NPI #1184092629 in Ellenton, Florida

Provider Information

NPI Number: 1184092629
Entity Type: Organization
Organization Name: Ellenton Family Dental Corp
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Sep 14, 2015
Last Updated: Sep 14, 2015

Practice Location

Address: 5975 FACTORY SHOPS BLVD
City: Ellenton
State: Florida
ZIP Code: 34222-4125
Phone: (941) 479-7936

Authorized Official

Name: CARLA M MATHEWS
Title: OFFICE MANAGER
Phone: (941) 479-7936

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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