Healthcare Provider Details

I. General information

NPI: 1003560863
Provider Name (Legal Business Name): ABF DENTAL PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 SAXON BLVD
ORANGE CITY FL
32763-8358
US

IV. Provider business mailing address

942 SAXON BLVD
ORANGE CITY FL
32763-8358
US

V. Phone/Fax

Practice location:
  • Phone: 386-774-0125
  • Fax: 386-960-7870
Mailing address:
  • Phone: 386-774-0125
  • Fax: 386-960-7870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANDREW YOON
Title or Position: OWNER
Credential: DMD
Phone: 386-774-0125