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General NPI Number Information
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NPI Number | 1184069064
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Entity Type | Organization
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Legal Business Name | BARAK DENTAL GROUP
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Dates
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Enumeration Date | 05/06/2013
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Last Update Date | 05/06/2013
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Provider Practice Location Address
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Address Line | 2608 PIONEER RD
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City | ORLANDO
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State | FL
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Zip | 32808-3221
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Country | US
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Telephone | 407-299-3232
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Fax |
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Provider Business Mailing Address
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Address Line | 2608 PIONEER RD
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City | ORLANDO
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State | FL
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Zip | 32808
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Country | US
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Telephone | 407-299-3232
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JANICE SISTRUNK- CARLTON
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Credential | DDS
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Telephone | 407-299-3232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN9771
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License Number State | FL
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