Provider Demographics
NPI:1952144529
Name:WOLCOTT, DESTINY FAITH (DMD)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:FAITH
Last Name:WOLCOTT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DESTINY
Other - Middle Name:FAITH
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 BRICKELL ST SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-4471
Mailing Address - Country:US
Mailing Address - Phone:321-292-4058
Mailing Address - Fax:
Practice Address - Street 1:1890 PALM BAY RD NE STE 2
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3071
Practice Address - Country:US
Practice Address - Phone:321-724-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist