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General NPI Number Information
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NPI Number | 1457726911
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Entity Type | Organization
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Legal Business Name | 113TH STREET SEMINOLE ORTHODONTICS LLC
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Dates
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Enumeration Date | 12/09/2015
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 8500 113TH ST
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City | SEMINOLE
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State | FL
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Zip | 33772-4126
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Country | US
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Telephone | 727-399-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 8500 113TH ST
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City | SEMINOLE
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State | FL
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Zip | 33772-4126
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Country | US
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Telephone | 727-399-2000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BILL LAYMAN
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Credential | D.M.D.
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Telephone | 727-399-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 15686
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License Number State | FL
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