Healthcare Provider Details

I. General information

NPI: 1548165749
Provider Name (Legal Business Name): SPECIAL DENTAL OF FLORIDA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HAYS ST
TALLAHASSEE FL
32301-2699
US

IV. Provider business mailing address

4350 BROWNSBORO RD STE 210 STE 210
LOUISVILLE KY
40207-1681
US

V. Phone/Fax

Practice location:
  • Phone: 248-528-2116
  • Fax: 502-996-8282
Mailing address:
  • Phone: 248-528-2116
  • Fax: 502-996-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAURENCE E FENDRICH
Title or Position: OWNER
Credential:
Phone: 512-301-1505