Provider Demographics
NPI:1528521671
Name:GULF BREEZE FAMILY DENTISTRY
Entity type:Organization
Organization Name:GULF BREEZE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBROCHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-375-8098
Mailing Address - Street 1:6019 E CAMBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-7375
Mailing Address - Country:US
Mailing Address - Phone:850-375-8098
Mailing Address - Fax:
Practice Address - Street 1:1371 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3451
Practice Address - Country:US
Practice Address - Phone:850-375-8098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-07
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental