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General NPI Number Information
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NPI Number | 1154694321
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Entity Type | Organization
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Legal Business Name | SILVER STAR DENTAL CENTER INC.
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Dates
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Enumeration Date | 02/17/2012
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 5028 SILVER STAR RD
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City | ORLANDO
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State | FL
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Zip | 32808-4545
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Country | US
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Telephone | 407-291-1997
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Fax | 407-291-4909
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Provider Business Mailing Address
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Address Line | 5028 SILVER STAR RD
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City | ORLANDO
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State | FL
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Zip | 32808-4545
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Country | US
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Telephone | 407-291-1997
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Fax | 407-291-4909
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Authorized Official
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Title or Position | OWNER/DR
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Name | DR. WAFIEK NAKHLA
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Credential | D.M.D.
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Telephone | 407-291-1997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN13724
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License Number State | FL
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