| Organization Name: | ARTISTIC DENTAL OF POLK CITY, LLC |
| NPI Number: | 1528301058 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID W GOLDSTON (MEMBER) |
| Mailing Address: | 120 Carter Blvd Suite 7 Polk City |
| State: | FL US |
| Postal Code: | 338688908 |
| Phone Number: | 8639840000 |
| Fax Number: | |
| NPI Enumeration Date: | 04/03/2013 |
| NPI Last Update Date: | 04/03/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | DN4587 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |