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General NPI Number Information
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NPI Number | 1346681491
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Entity Type | Organization
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Legal Business Name | WEKIVA PLACE, PA
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Dates
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Enumeration Date | 07/17/2013
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 686 N HUNT CLUB BLVD WEKIVA PLACE, SUITE 100
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City | LONGWOOD
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State | FL
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Zip | 32779-2218
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Country | US
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Telephone | 407-869-7333
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Fax | 407-869-5720
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Provider Business Mailing Address
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Address Line | 686 N HUNT CLUB BLVD WEKIVA PLACE, SUITE 100
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City | LONGWOOD
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State | FL
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Zip | 32779-2218
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Country | US
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Telephone | 407-869-7333
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Fax | 407-869-5720
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK S. OFFENBACK
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Credential | D.D.S.
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Telephone | 407-869-7333
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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 | DN10359
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License Number State | FL
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