Healthcare Provider Details

I. General information

NPI: 1073160487
Provider Name (Legal Business Name): CENTER FOR INTEGRATIVE ORAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7151 UNIVERSITY BLVD UNIT 110
WINTER PARK FL
32792-6724
US

IV. Provider business mailing address

7151 UNIVERSITY BLVD UNIT 110
WINTER PARK FL
32792-6724
US

V. Phone/Fax

Practice location:
  • Phone: 407-664-6999
  • Fax:
Mailing address:
  • Phone: 407-664-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code125Q00000X
TaxonomyOral Medicine Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JAISRI R THOPPAY
Title or Position: PRESIDENT
Credential: DDS
Phone: 407-664-6999