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General NPI Number Information
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NPI Number | 1255043618
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Entity Type | Organization
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Legal Business Name | OCOEE DENTAL CARE PLLC
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Dates
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Enumeration Date | 12/16/2022
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 64 MOUSE CREEK RD NW
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City | CLEVELAND
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State | TN
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Zip | 37312-4800
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Country | US
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Telephone | 423-790-1311
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Fax |
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Provider Business Mailing Address
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Address Line | 64 MOUSE CREEK RD NW
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City | CLEVELAND
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State | TN
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Zip | 37312-4800
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Country | US
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Telephone | 423-790-1311
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. AN TA
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Credential | DMD
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Telephone | 858-774-5663
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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 |
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License Number State |
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