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General NPI Number Information
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NPI Number | 1366001471
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Entity Type | Organization
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Legal Business Name | ATA DENTAL KISSIMMEE LLC
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 3192 S JOHN YOUNG PKWY STE B
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City | KISSIMMEE
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State | FL
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Zip | 34746-8814
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Country | US
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Telephone | 407-870-5151
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Fax | 407-870-2556
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Provider Business Mailing Address
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Address Line | 3192 S JOHN YOUNG PKWY
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City | KISSIMMEE
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State | FL
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Zip | 34746-8814
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Country | US
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Telephone | 407-870-5151
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Fax | 407-870-2556
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH ATA
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Credential | DMD
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Telephone | 407-870-5151
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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 |
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License Number State |
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