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General NPI Number Information
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NPI Number | 1427942143
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Entity Type | Organization
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Legal Business Name | MOUNT DORA FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 18660 HIGHWAY 441 SUITE 106
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City | MOUNT DORA
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State | FL
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Zip | 32757
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Country | US
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Telephone | 352-755-1020
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Fax |
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Provider Business Mailing Address
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Address Line | 18660 HIGHWAY 441 SUITE 106
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City | MOUNT DORA
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State | FL
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Zip | 32757
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Country | US
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Telephone | 352-755-1020
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Fax | 407-574-4651
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Authorized Official
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Title or Position | OWNER
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Name | PETER KELLY
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Credential |
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Telephone | 407-432-6224
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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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