Healthcare Provider Details

I. General information

NPI: 1407764624
Provider Name (Legal Business Name): OLLIE DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WINTER GARDEN VINELAND RD
WINTER GARDEN FL
34787-5483
US

IV. Provider business mailing address

4961 S ORANGE AVE
ORLANDO FL
32806-6957
US

V. Phone/Fax

Practice location:
  • Phone: 407-654-1296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEFHANY G DUQUE ROSAS
Title or Position: OWNER
Credential: DMD
Phone: 239-738-9019