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General NPI Number Information
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NPI Number | 1154838365
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Entity Type | Organization
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Legal Business Name | TREVISANI ORAL SURGERY ORLANDO PLC
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 01/09/2018
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Provider Practice Location Address
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Address Line | 10967 LAKE UNDERHILL RD STE 144
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City | ORLANDO
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State | FL
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Zip | 32825-4456
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Country | US
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Telephone | 407-764-9900
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Fax | 407-764-9902
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Provider Business Mailing Address
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Address Line | 511 WEKIVA COMMONS CIR
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City | APOPKA
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State | FL
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Zip | 32712-3645
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Country | US
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Telephone | 407-886-2050
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Fax | 407-886-2117
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TAMI VARGAS
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Credential |
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Telephone | 407-886-2050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN13576
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License Number State | FL
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