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General NPI Number Information
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NPI Number | 1326535279
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Entity Type | Organization
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Legal Business Name | CITRUS ORAL AND FACIAL SURGERY AT OCALA, LLC
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 6129 W CORPORATE OAKS DR
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-8732
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Country | US
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Telephone | 352-795-4994
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Fax | 352-795-4609
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Provider Business Mailing Address
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Address Line | 2611 SE 17TH ST STE A
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City | OCALA
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State | FL
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Zip | 34471-5587
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Country | US
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Telephone | 352-509-6500
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Fax | 352-509-6556
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MISTY C BLOMBERG
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Credential |
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Telephone | 522-509-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN17708
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License Number State | FL
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