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General NPI Number Information
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NPI Number | 1205901055
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Entity Type | Organization
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Legal Business Name | ORAL-FACIAL SURGICAL ARTS PA
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 06/30/2011
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Provider Practice Location Address
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Address Line | 3180 CITRUS TOWER BLVD
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City | CLERMONT
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State | FL
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Zip | 34711
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Country | US
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Telephone | 352-243-5599
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Fax |
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Provider Business Mailing Address
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Address Line | 13147 AUBREY LANE
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City | WINTER GARDEN
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State | FL
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Zip | 34787
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Country | US
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Telephone | 352-243-5599
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD MICHAEL ACHONG
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Credential | DMD, MD
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Telephone | 352-243-5599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN16913
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License Number State | FL
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