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General NPI Number Information
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NPI Number | 1346368313
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Entity Type | Organization
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Legal Business Name | COLONIAL DENTAL CARE,INC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5074 W COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32808-7668
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Country | US
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Telephone | 407-299-9099
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Fax | 407-295-9505
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Provider Business Mailing Address
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Address Line | 5074 W COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32808-7668
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Country | US
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Telephone | 407-299-9099
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Fax | 407-295-9505
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Authorized Official
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Title or Position | OWNER,DENTIST
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Name | THAI K LA
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Credential | DDS
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Telephone | 407-299-9099
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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 | DN-17475
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License Number State | FL
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