Healthcare Provider Details

I. General information

NPI: 1396669271
Provider Name (Legal Business Name): ROOT CANAL SPECIALIST OF ORLANDO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4861 S ORANGE AVE STE C
ORLANDO FL
32806-6949
US

IV. Provider business mailing address

4861 S ORANGE AVE STE C
ORLANDO FL
32806-6949
US

V. Phone/Fax

Practice location:
  • Phone: 407-604-4115
  • Fax: 407-542-7463
Mailing address:
  • Phone: 407-604-4115
  • Fax: 407-542-7463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES B LOGSDON
Title or Position: PROVIDER/OWNER
Credential: D.D.S.
Phone: 407-890-9116