Healthcare Provider Details

I. General information

NPI: 1033279641
Provider Name (Legal Business Name): ORIN JAY OBERLANDER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30470 BETTS RD
MYAKKA CITY FL
34251-9596
US

IV. Provider business mailing address

30470 BETTS RD
MYAKKA CITY FL
34251-9596
US

V. Phone/Fax

Practice location:
  • Phone: 941-322-1280
  • Fax:
Mailing address:
  • Phone: 941-322-1280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15056
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: