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General NPI Number Information
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NPI Number | 1265766273
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Entity Type | Organization
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Legal Business Name | LG DENTAL GROUP
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 12927 S ORANGE BLOSSOM TRL
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City | ORLANDO
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State | FL
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Zip | 32837-6592
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Country | US
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Telephone | 407-240-4900
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Fax | 407-240-1113
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Provider Business Mailing Address
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Address Line | 12927 S ORANGE BLOSSOM TRL
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City | ORLANDO
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State | FL
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Zip | 32837-6592
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Country | US
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Telephone | 407-240-4900
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | LUZ M GUERRA
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Credential | D.D.S
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Telephone | 407-240-4900
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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 |
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License Number State |
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