Healthcare Provider Details

I. General information

NPI: 1538907001
Provider Name (Legal Business Name): DENTAL ARTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1378 S NARCOOSSEE RD
SAINT CLOUD FL
34771-7251
US

IV. Provider business mailing address

13136 ALDERLEY DR
ORLANDO FL
32832-6342
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-0600
  • Fax:
Mailing address:
  • Phone: 407-733-6816
  • Fax:

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: GABRIELA ANDREINA ROMERO SALINAS
Title or Position: MANAGER
Credential: DDS
Phone: 407-733-6816