Healthcare Provider Details

I. General information

NPI: 1346303658
Provider Name (Legal Business Name): W. K. FRAVEL, D.M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1291 BLACKWOOD AVE
OCOEE FL
34761-4521
US

IV. Provider business mailing address

1291 BLACKWOOD AVE
OCOEE FL
34761-4521
US

V. Phone/Fax

Practice location:
  • Phone: 407-656-0001
  • Fax: 407-656-5290
Mailing address:
  • Phone: 407-656-0001
  • Fax: 407-656-5290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8872
License Number StateFL

VIII. Authorized Official

Name: MRS. JEANNE A. FRAVEL
Title or Position: OFFICE MANAGER
Credential:
Phone: 407-656-0001