Healthcare Provider Details

I. General information

NPI: 1124013024
Provider Name (Legal Business Name): GEORGE BRADFORD DEESE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7051 DR PHILLIPS BLVD STE 9
ORLANDO FL
32819-5140
US

IV. Provider business mailing address

9242 BAY POINT DR
ORLANDO FL
32819-4806
US

V. Phone/Fax

Practice location:
  • Phone: 407-363-4800
  • Fax:
Mailing address:
  • Phone: 352-682-5493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN16697
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: