Healthcare Provider Details

I. General information

NPI: 1003710377
Provider Name (Legal Business Name): FRAGOSO DENTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9151 ESTATE THOMAS STE 202
ST THOMAS VI
00802-2716
US

IV. Provider business mailing address

9151 ESTATE THOMAS STE 202
ST THOMAS VI
00802-2716
US

V. Phone/Fax

Practice location:
  • Phone: 407-590-8363
  • Fax:
Mailing address:
  • Phone: 407-590-8363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ASHLEY DACHEL FRAGOSO
Title or Position: OWNER
Credential: DDS
Phone: 407-590-8363