Healthcare Provider Details

I. General information

NPI: 1972609055
Provider Name (Legal Business Name): OROFACIAL & DENTAL IMPLANT SURGERY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7352 STONEROCK CIR SUITE A
ORLANDO FL
32819-8000
US

IV. Provider business mailing address

7352 STONEROCK CIR SUITE A
ORLANDO FL
32819-8000
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-0575
  • Fax: 407-363-6945
Mailing address:
  • Phone: 407-351-0575
  • Fax: 407-363-6945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN12934
License Number StateFL

VIII. Authorized Official

Name: DR. OFILIO J MORALES
Title or Position: PRESIDENT
Credential: D.M.D
Phone: 407-351-0575