Healthcare Provider Details

I. General information

NPI: 1194841825
Provider Name (Legal Business Name): ANDRE BEN BAPTISTE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8907 CONROY WINDERMERE RD
ORLANDO FL
32835
US

IV. Provider business mailing address

9301 LAKE HUGH COVE CT
GOTHA FL
34734-4627
US

V. Phone/Fax

Practice location:
  • Phone: 407-217-2927
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN15927
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: