| Dennis Lichorwic Dmd Pa | |
|
4635 Gulfstarr Dr Destin FL 32541-5780 | |
| (850) 654-8665 | |
| (850) 654-9584 |
| Full Name | Dennis Lichorwic Dmd Pa |
|---|---|
| Speciality | Dentist |
| Location | 4635 Gulfstarr Dr, Destin, Florida |
| Authorized Official Name and Position | Dennis Wayne Lichorwic (OWNER/PRESIDENT) |
| Authorized Official Contact | 8506548665 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dennis Lichorwic Dmd Pa 4635 Gulfstarr Dr Destin FL 32541-5780 Ph: (850) 654-8665 | Dennis Lichorwic Dmd Pa 4635 Gulfstarr Dr Destin FL 32541-5780 Ph: (850) 654-8665 |
| NPI Number | 1679990501 |
|---|---|
| Provider Enumeration Date | 03/28/2014 |
| Last Update Date | 03/28/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679990501 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 0014608 (Florida) | Primary |
| 122300000X | Dentist | DN19333 (Florida) | Secondary |
| 122300000X | Dentist | DN19829 (Florida) | Secondary |
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