Healthcare Provider Details

I. General information

NPI: 1659283885
Provider Name (Legal Business Name): OCALA DENTAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 SE 17TH ST
OCALA FL
34471-5522
US

IV. Provider business mailing address

3909 NEWBERRY RD STE G
GAINESVILLE FL
32607-2367
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-5646
  • Fax:
Mailing address:
  • Phone: 850-326-2246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: HALEY NEEDHAM
Title or Position: INS COORDINATOR
Credential:
Phone: 850-326-2246