Healthcare Provider Details

I. General information

NPI: 1992529861
Provider Name (Legal Business Name): BUENA VISTA FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11444 S APOPKA VINELAND RD UNIT 101
ORLANDO FL
32836-7009
US

IV. Provider business mailing address

11444 S APOPKA VINELAND RD UNIT 101
ORLANDO FL
32836-7009
US

V. Phone/Fax

Practice location:
  • Phone: 407-930-0060
  • Fax: 407-955-4888
Mailing address:
  • Phone: 407-930-0060
  • Fax: 407-955-4888

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: XIMENA ALDEA
Title or Position: DENTIST/PRESIDENT
Credential: DMD
Phone: 407-748-8290