Healthcare Provider Details

I. General information

NPI: 1083532220
Provider Name (Legal Business Name): ASHLEY DACHEL FRAGOSO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13559 NARCOOSSEE RD
ORLANDO FL
32832-7136
US

IV. Provider business mailing address

10514 KIRBY SMITH RD
ORLANDO FL
32832-5929
US

V. Phone/Fax

Practice location:
  • Phone: 407-476-5650
  • Fax:
Mailing address:
  • Phone: 407-590-8363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN32124
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: