Healthcare Provider Details

I. General information

NPI: 1861694895
Provider Name (Legal Business Name): BUENA VISTA DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 LAUREL MANOR DR SUITE #160
THE VILLAGES FL
32162-5603
US

IV. Provider business mailing address

1950 LAUREL MANOR DRIVE SUITE #160
THE VILLAGES FL
32162
US

V. Phone/Fax

Practice location:
  • Phone: 352-259-7950
  • Fax: 352-430-0428
Mailing address:
  • Phone: 352-259-7950
  • Fax: 352-430-0428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14138
License Number StateFL

VIII. Authorized Official

Name: DR. DAVID F. BARNETT
Title or Position: OWNER
Credential: D.M.D.
Phone: 352-259-7950