Organization Name: | LAFAYETTE COUNTY HEALTH DEPARTMENT-DENTAL CLINIC |
NPI Number: | 1447268354 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SANDRA KIM PEPPER (BUSINESS MANAGER) |
Mailing Address: | 140 Sw Virginia Cir Mayo |
State: | FL US |
Postal Code: | 320664064 |
Phone Number: | 3862942012 |
Fax Number: | 3862943457 |
NPI Enumeration Date: | 08/04/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251K00000X |
License Number: | DN 14318 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Public Health or Welfare |
Taxonomy Specialization: | |
Taxonomy Definition: |