Healthcare Provider Details

I. General information

NPI: 1801758776
Provider Name (Legal Business Name): NEXUS PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15513 SUNQUAT DR STE 140
WINTER GARDEN FL
34787-5899
US

IV. Provider business mailing address

15513 SUNQUAT DR STE 140
WINTER GARDEN FL
34787-5899
US

V. Phone/Fax

Practice location:
  • Phone: 407-220-1515
  • Fax:
Mailing address:
  • Phone: 407-220-1515
  • 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: LAURA SANTOS
Title or Position: DR
Credential: DDS
Phone: 201-898-7327