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General NPI Number Information
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NPI Number | 1528935442
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Entity Type | Organization
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Legal Business Name | ENHANCED DENTAL CARE LLC
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Dates
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Enumeration Date | 10/23/2025
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 410 N DILLARD ST STE 101
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City | WINTER GARDEN
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State | FL
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Zip | 34787-2853
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Country | US
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Telephone | 407-656-4848
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Fax | 407-656-3661
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Provider Business Mailing Address
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Address Line | 410 N DILLARD ST STE 101
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City | WINTER GARDEN
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State | FL
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Zip | 34787-2853
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Country | US
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Telephone | 407-656-4848
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Fax | 407-656-3661
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MICHAEL SOUTAS
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Credential |
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Telephone | 407-656-4848
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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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