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NPI Code Detail

MEDICARE: ORLANDO ORAL & FACIAL SURGERY PLLC

MEDICARE: ORLANDO ORAL & FACIAL SURGERY PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0106XOral and Maxillofacial Pathology Dentistry
21223X0008XOral and Maxillofacial Radiology Dentistry
3174400000XSpecialist
41223S0112XOral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number : 1205920204
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORLANDO ORAL & FACIAL SURGERY PLLC
Provider Business Mailing Address
First Line : 2045 LEE RD
Second Line :
City : WINTER PARK
State : FL
Zip : 32789-1836
Country : US
Telephone Number : 407-629-4444
Fax Number : 407-629-9078
Provider Business Practice Location Address
First Line : 2045 LEE RD
Second Line :
City : WINTER PARK
State : FL
Zip : 32789-1836
Country : US
Telephone Number : 407-629-4444
Fax Number : 407-629-9078
Authorized Official
Title or Position : ACCOUNTS PAYABLE
Name : MRS. EVELIS GERENA
Credential :
Telephone Number : 407-629-4444
Provider Enumeration Date : 10/03/2006
Last Update Date : 06/02/2016

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