MEDICARE: WINTER PARK DENTAL PA

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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1548013600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINTER PARK DENTAL PA

Provider Business Mailing Address
First Line	:	1435 W FAIRBANKS AVE
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4805
Country	:	US
Telephone Number	:	407-644-5627
Fax Number	:

Provider Business Practice Location Address
First Line	:	1435 W FAIRBANKS AVE
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4805
Country	:	US
Telephone Number	:	407-644-5627
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FIRAS MAROUF
Credential	:	DMD
Telephone Number	:	407-644-5627

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	04/09/2024

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Directions to “WINTER PARK DENTAL PA ” Practice Location

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