| My Favorite Dental Boutique Llc | |
|
1670 S Us Highway 17 92 Longwood FL 32750-6516 | |
| (407) 274-4744 | |
| Not Available |
| Full Name | My Favorite Dental Boutique Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1670 S Us Highway 17 92, Longwood, Florida |
| Authorized Official Name and Position | Paula Grisales Cano (OWNER) |
| Authorized Official Contact | 4072744744 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| My Favorite Dental Boutique Llc 1670 S Us Highway 17 92 Longwood FL 32750-6516 Ph: (407) 274-4744 | My Favorite Dental Boutique Llc 1670 S Us Highway 17 92 Longwood FL 32750-6516 Ph: (407) 274-4744 |
| NPI Number | 1255182515 |
|---|---|
| Provider Enumeration Date | 03/27/2024 |
| Last Update Date | 03/27/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255182515 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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