Healthcare Provider Details

I. General information

NPI: 1730921271
Provider Name (Legal Business Name): EKOS BVL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 07/16/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 E OSCEOLA PKWY
KISSIMMEE FL
34743-8630
US

IV. Provider business mailing address

8794 BOYNTON BEACH BLVD STE 218
BOYNTON BEACH FL
33472-4469
US

V. Phone/Fax

Practice location:
  • Phone: 407-201-3998
  • Fax:
Mailing address:
  • Phone: 561-899-7115
  • Fax:

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: SEAN TOMALTY
Title or Position: OWNER
Credential: D.M.D
Phone: 561-789-6611