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General NPI Number Information
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NPI Number | 1255816906
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Entity Type | Organization
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Legal Business Name | SOH OF FLORIDA PA
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Dates
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Enumeration Date | 09/28/2018
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 610 N MILLS AVE STE 200
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City | ORLANDO
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State | FL
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Zip | 32803-7113
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Country | US
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Telephone | 407-674-8770
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Fax |
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Provider Business Mailing Address
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Address Line | 1422 ELBRIDGE PAYNE RD STE 240
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City | CHESTERFIELD
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State | MO
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Zip | 63017-8544
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Country | US
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Telephone | 636-362-4986
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | ASHLY SUNSHINE
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Credential |
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Telephone | 314-413-2803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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