MEDICARE: YOUR KISSIMMEE DENTIST 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	122300000X	Dentist

General Provider Information

NPI Number	:	1750115424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR KISSIMMEE DENTIST PA

Provider Business Mailing Address
First Line	:	13151 PALOMA DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-8723
Country	:	US
Telephone Number	:	808-407-8085
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 W COLUMBIA AVE
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-3202
Country	:	US
Telephone Number	:	407-933-4343
Fax Number	:	407-944-1434

Authorized Official
Title or Position	:	DENTIST
Name	:	CARLOS MEDINA
Credential	:	DMD
Telephone Number	:	386-717-5458

Provider Enumeration Date	:	08/27/2024
Last Update Date	:	08/27/2024

Similar Medicare Providers

1598303588 — LASTING SMILES OF KISSIMMEE LLC
Practice Location Address:

1135 W COLUMBIA AVE
KISSIMMEE, FL
34741-3202

Practice Phone: 407-933-4343
Practice Fax:

1134922792 — HELPING KIDS IS OUR HAPPY PLACE PEDIATRIC THERAPY, INC
Practice Location Address:

2684 ALMOND AVE FL 34746
KISSIMMEE, FL
34746-3202

Practice Phone: 407-346-6850
Practice Fax: 407-346-6850

1497615793 — MS. MARIA E DE LA CRUZ NP
Practice Location Address:

931 W OAK ST STE 103
KISSIMMEE, FL
34741-4973

Practice Phone: 407-931-0444
Practice Fax: 407-962-4446

1891659595 — BIANCA ELENA SOUKOVA JEAN OTA
Practice Location Address:

3227 HILLSDALE LN
KISSIMMEE, FL
34741-7561

Practice Phone: 407-990-2847
Practice Fax:

1417428095 — MARIA E DE LA CRUZ APRN
Practice Location Address:

200 PARK PLACE BLVD
KISSIMMEE, FL
34741-2344

Practice Phone: 407-846-0023
Practice Fax: 407-483-0378

1518822196 — ADONIS RAMON PEREZ FABRA
Practice Location Address:

3282 GREENWALD WAY N
KISSIMMEE, FL
34741-0728

Practice Phone: 321-355-3904
Practice Fax:

Directions to “YOUR KISSIMMEE DENTIST PA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.