Healthcare Provider Details

I. General information

NPI: 1699326603
Provider Name (Legal Business Name): NORTH CENTRAL FLORIDA ENDODONTICS,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 SE 16TH AVE
OCALA FL
34471-2521
US

IV. Provider business mailing address

1905 NW 13TH ST STE 2
GAINESVILLE FL
32609-3414
US

V. Phone/Fax

Practice location:
  • Phone: 352-629-5898
  • Fax: 352-629-3995
Mailing address:
  • Phone: 352-375-7776
  • Fax: 352-375-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: LISA THOMAS
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 352-375-7776