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General NPI Number Information
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NPI Number | 1447483920
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Entity Type | Organization
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Legal Business Name | PARK DENTAL OF OCALA, PA
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 3101 SW 34TH AVE STE 600
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City | OCALA
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State | FL
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Zip | 34474-8476
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Country | US
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Telephone | 352-861-2510
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Fax | 352-861-2498
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Provider Business Mailing Address
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Address Line | 3101 SW 34TH AVE STE 600
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City | OCALA
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State | FL
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Zip | 34474-8476
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Country | US
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Telephone | 352-861-2510
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Fax | 352-861-2498
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Authorized Official
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Title or Position | CEO
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Name | DR. JENNIFER A LARSON
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Credential | DMD
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Telephone | 352-861-2510
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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 | DN18061
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License Number State | FL
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