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General NPI Number Information
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NPI Number | 1154899763
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Entity Type | Organization
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Legal Business Name | VOLUSIA ENDODONTICS-MAITLAND
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 670 N ORLANDO AVE STE 203
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City | MAITLAND
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State | FL
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Zip | 32751-4465
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Country | US
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Telephone | 407-581-9515
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Fax |
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Provider Business Mailing Address
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Address Line | 670 N ORLANDO AVE STE 203
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City | MAITLAND
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State | FL
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Zip | 32751-4465
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Country | US
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Telephone | 407-581-9515
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SUSIE BOBO
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Credential |
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Telephone | 407-581-9515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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