Davidson Dental Interests LLC
Clinic/Center, Dental in Brandon, FL. Organization (NPI-2).
NPI number1689554164
StatusActive
Last updated in NPPESSep 4, 2025
Details
- NPI
- 1689554164
- Entity type
- Organization (NPI-2)
- Legal business name
- Davidson Dental Interests LLC
- Organization subpart
- No
- Enumeration date
- Sep 4, 2025
- Certification date
- Sep 4, 2025
- Last updated
- Sep 4, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Other names
- Welly Dental Studio (Doing Business As)
Practice location
716 S Oakwood AveBrandon, FL 33511-6124
Phone 813-494-0091
Mailing address
11239 Fish Eagle DrRiverview, FL 33569-5742
Authorized official
Susan Agnes Davidson
Dentist
8134940091
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