Healthcare Provider Details

I. General information

NPI: 1639464852
Provider Name (Legal Business Name): ORLANDO DENTAL SLEEP MEDICINE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 ORANGE AVE #106
WINTER PARK FL
32789-4945
US

IV. Provider business mailing address

1350 ORANGE AVE #106
WINTER PARK FL
32789-4945
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-1744
  • Fax: 407-647-0139
Mailing address:
  • Phone: 407-647-1744
  • Fax: 407-647-0139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15265
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number15265
License Number StateFL

VIII. Authorized Official

Name: DR. ZACHARY WILLIAM HODGINS
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 407-647-1744