Healthcare Provider Details

I. General information

NPI: 1083325583
Provider Name (Legal Business Name): MARK DREYER, D.M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 N CENTRAL AVE
KISSIMMEE FL
34741-5029
US

IV. Provider business mailing address

909 N CENTRAL AVE
KISSIMMEE FL
34741-5029
US

V. Phone/Fax

Practice location:
  • Phone: 407-933-0885
  • Fax: 407-933-0520
Mailing address:
  • Phone: 407-933-0885
  • Fax: 407-933-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CELIA PAKULA
Title or Position: ADMIN/TEAM SUPPORT
Credential:
Phone: 407-713-5785