Healthcare Provider Details

I. General information

NPI: 1194790097
Provider Name (Legal Business Name): VICTOR R FIRST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W AIRPORT BLVD
SANFORD FL
32773-5489
US

IV. Provider business mailing address

1097 EAGLES WATCH TRL
WINTER SPRINGS FL
32708-5029
US

V. Phone/Fax

Practice location:
  • Phone: 407-665-3346
  • Fax: 407-665-3213
Mailing address:
  • Phone: 407-699-4147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN8323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: