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General NPI Number Information
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NPI Number | 1366566903
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Entity Type | Organization
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Legal Business Name | LAKE BUENA VISTA DENTAL P.A.
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12131 S. APOPKA-VINELAND ROAD
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City | ORLANDO
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State | FL
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Zip | 32801
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Country | US
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Telephone | 407-239-8883
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Fax |
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Provider Business Mailing Address
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Address Line | 12131 S. APOPKA-VINELAND ROAD
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City | ORLANDO
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State | FL
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Zip | 32801
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INSURANCE DIRECTOR
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Name | MIKE COLE
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Credential |
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Telephone | 727-726-1611
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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 |
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License Number State |
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