=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184919334
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC MICHAEL SERRANO D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2011
-----------------------------------------------------
Last Update Date | 06/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14811 E COLONIAL DR STE 100
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32826-5116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-535-5909
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4914 LIVINGSTON LN
-----------------------------------------------------
City | OVIEDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32765-8545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-535-5909
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | DN19363
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------