MEDICARE: BUENA VISTA FAMILY DENTISTRY

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1992529861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUENA VISTA FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	11444 S APOPKA VINELAND RD UNIT 101
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32836-7009
Country	:	US
Telephone Number	:	407-930-0060
Fax Number	:	407-955-4888

Provider Business Practice Location Address
First Line	:	11444 S APOPKA VINELAND RD UNIT 101
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32836-7009
Country	:	US
Telephone Number	:	407-930-0060
Fax Number	:	407-955-4888

Authorized Official
Title or Position	:	DENTIST/PRESIDENT
Name	:	XIMENA ALDEA
Credential	:	DMD
Telephone Number	:	407-748-8290

Provider Enumeration Date	:	11/08/2024
Last Update Date	:	11/08/2024

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Directions to “BUENA VISTA FAMILY DENTISTRY ” Practice Location

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