=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124989231
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKE BALDWIN DENTAL OF ORLANDO PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2025
-----------------------------------------------------
Last Update Date | 11/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 950 LAKE BALDWIN LN
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32814-6651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-515-8500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 950 LAKE BALDWIN LN
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32814-6651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-515-8500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER/GENERAL DENTIST
-----------------------------------------------------
Name | DR. JARED NESTLE
-----------------------------------------------------
Credential | D.M.D
-----------------------------------------------------
Telephone | 407-873-3788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------