Healthcare Provider Details

I. General information

NPI: 1851903298
Provider Name (Legal Business Name): OCOEE DENTAL & ORTHODONTICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 MAGUIRE RD STE 1005
OCOEE FL
34761-4742
US

IV. Provider business mailing address

2910 MAGUIRE RD STE 1005
OCOEE FL
34761-4742
US

V. Phone/Fax

Practice location:
  • Phone: 772-539-2591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MAITRI PATEL
Title or Position: PRESIDENT
Credential: D.M.D
Phone: 772-539-2591