Healthcare Provider Details

I. General information

NPI: 1306907274
Provider Name (Legal Business Name): MARK F. HALEK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 EXECUTIVE PARK CT STE 1600
APOPKA FL
32703-6045
US

IV. Provider business mailing address

660 EXECUTIVE PARK CT STE 1600
APOPKA FL
32703-6045
US

V. Phone/Fax

Practice location:
  • Phone: 407-774-4433
  • Fax: 407-774-8475
Mailing address:
  • Phone: 407-774-4433
  • Fax: 407-774-8475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN0012703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: