Healthcare Provider Details

I. General information

NPI: 1952731887
Provider Name (Legal Business Name): EAST ORANGE ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 DYLAN LOREN CIR SUITE 103
ORLANDO FL
32825-4437
US

IV. Provider business mailing address

10800 DYLAN LOREN CIR SUITE 103
ORLANDO FL
32825-4437
US

V. Phone/Fax

Practice location:
  • Phone: 407-704-7863
  • Fax: 321-248-0330
Mailing address:
  • Phone: 407-704-7863
  • Fax: 321-248-0330

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: MR. MAURICIO CHAVARRIAGA
Title or Position: DDS
Credential:
Phone: 407-704-7863