Healthcare Provider Details

I. General information

NPI: 1366364457
Provider Name (Legal Business Name): ADVANTAGE DENTAL ORAL HEALTH CENTER OF FLORIDA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27151 HALTER LOOP
WESLEY CHAPEL FL
33544
US

IV. Provider business mailing address

PO BOX 410042
BOSTON MA
02241-0042
US

V. Phone/Fax

Practice location:
  • Phone: 850-308-1600
  • Fax:
Mailing address:
  • Phone: 760-709-6099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE GOULD
Title or Position: ASSOCIATE DIRECTOR, RCM PAYOR RELAT
Credential:
Phone: 760-709-6099