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General NPI Number Information
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NPI Number | 1255754065
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA DENTAL CARE, LLC
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 2390 W OLD US HIGHWAY 441 STE #2
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City | MOUNT DORA
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State | FL
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Zip | 32757-3534
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Country | US
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Telephone | 352-383-3368
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Fax | 352-383-9865
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Provider Business Mailing Address
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Address Line | 2390 W OLD 441 STE 1
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City | MOUNT DORA
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State | FL
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Zip | 32757-3534
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Country | US
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Telephone | 352-735-5255
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Fax | 352-383-9865
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SONIA E JOHARY
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Credential |
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Telephone | 352-735-5255
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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 | DN 13227
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License Number State | FL
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