Healthcare Provider Details

I. General information

NPI: 1689740490
Provider Name (Legal Business Name): KEITH G KANTER DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4861 SOUTH ORANGE AVE SUITE C
ORLANDO FL
32806
US

IV. Provider business mailing address

4861 SOUTH ORANGE AVE SUITE C
ORLANDO FL
32806
US

V. Phone/Fax

Practice location:
  • Phone: 407-851-2996
  • Fax: 407-851-3025
Mailing address:
  • Phone: 407-851-2996
  • Fax: 407-851-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number007277
License Number StateFL

VIII. Authorized Official

Name: DR. KEITH G KANTER
Title or Position: OWNER PRESIDENT
Credential: DDS
Phone: 407-851-2996