Healthcare Provider Details

I. General information

NPI: 1609576594
Provider Name (Legal Business Name): RENATO J. AVES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N EDINBURGH DR STE A
WINTER PARK FL
32792-4157
US

IV. Provider business mailing address

7720 W WATERS AVE
TAMPA FL
33615-1813
US

V. Phone/Fax

Practice location:
  • Phone: 813-885-6555
  • Fax:
Mailing address:
  • Phone: 727-439-5695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JULIE MARIE WANGELIN
Title or Position: COO
Credential:
Phone: 813-885-6555