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Fundora My Dentist. LLC

Clinic/Center, Dental in Clearwater, FL. Organization (NPI-2).

NPI number1447979331
StatusActive
Last updated in NPPESAug 24, 2022

Details

NPI
1447979331
Entity type
Organization (NPI-2)
Legal business name
Fundora My Dentist. LLC
Organization subpart
No
Enumeration date
Aug 24, 2022
Certification date
Aug 18, 2022
Last updated
Aug 24, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QD0000X Clinic/Center, Dental––Yes

Practice location

28550 Us 19th Hwy N
Clearwater, FL 33761

Phone 786-247-6079

Mailing address

28550 Us 19th Hwy N
Clearwater, FL 33761

Phone 786-247-6079

Authorized official

Marcel Fundora
Owner
7273001594

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