Healthcare Provider Details

I. General information

NPI: 1932032521
Provider Name (Legal Business Name): FOUR SEASON DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 S SEMORAN BLVD STE C
ORLANDO FL
32822-2403
US

IV. Provider business mailing address

4501 S SEMORAN BLVD STE C
ORLANDO FL
32822-2403
US

V. Phone/Fax

Practice location:
  • Phone: 407-381-3377
  • Fax: 407-282-4129
Mailing address:
  • Phone: 407-381-3377
  • Fax: 407-282-4129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: NADIA KAHOOK
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 954-446-5797