| Ultimate Dental Studio | |
|
4570 Clyde Morris Blvd Ste 1 Port Orange FL 32129-5402 | |
| (386) 355-4237 | |
| Not Available |
| Full Name | Ultimate Dental Studio |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 4570 Clyde Morris Blvd Ste 1, Port Orange, Florida |
| Authorized Official Name and Position | Hillary Thull (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175408946 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ultimate Dental Studio 4570 Clyde Morris Blvd Ste 1 Port Orange FL 32129-5402 | Ultimate Dental Studio 4570 Clyde Morris Blvd Ste 1 Port Orange FL 32129-5402 Ph: (386) 355-4237 |
| NPI Number | 1851136378 |
|---|---|
| Provider Enumeration Date | 06/26/2024 |
| Last Update Date | 06/27/2024 |
| Certification Date | 06/27/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851136378 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (NU) | Primary |
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