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General NPI Number Information
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NPI Number | 1346882982
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Entity Type | Organization
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Legal Business Name | ASHLEY PARK DENTAL ARTS
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 7651 ASHLEY PARK CT STE 406
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City | ORLANDO
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State | FL
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Zip | 32835-6114
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Country | US
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Telephone | 617-416-8016
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Fax |
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Provider Business Mailing Address
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Address Line | 7651 ASHLEY PARK CT STE 406
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City | ORLANDO
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State | FL
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Zip | 32835-6114
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Country | US
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Telephone | 617-416-8016
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Fax |
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Authorized Official
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Title or Position | DENTIST/ OWNER
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Name | CONNOR VAN
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Credential | DMD
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Telephone | 617-416-8016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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