MEDICARE: BRYAN D. OETH,DMD,COSMETIC & RESTORATIVE DENTAL CARE OF LAKE MARY, FL, 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	:	1770423410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRYAN D. OETH,DMD,COSMETIC & RESTORATIVE DENTAL CARE OF LAKE MARY, FL, PA

Provider Business Mailing Address
First Line	:	737 STIRLING CENTER PL STE 1801
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5715
Country	:	US
Telephone Number	:	407-805-8808
Fax Number	:	407-805-8905

Provider Business Practice Location Address
First Line	:	737 STIRLING CENTER PL STE 1801
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5715
Country	:	US
Telephone Number	:	407-805-8808
Fax Number	:	407-805-8905

Authorized Official
Title or Position	:	DENTIST/VICE PRESIDENT
Name	:	PETER IBRAHIM
Credential	:	DMD
Telephone Number	:	321-276-8465

Provider Enumeration Date	:	03/31/2026
Last Update Date	:	03/31/2026

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