=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548165749
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECIAL DENTAL OF FLORIDA PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2026
-----------------------------------------------------
Last Update Date | 10/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 HAYS ST
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32301-2699
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-528-2116
-----------------------------------------------------
Fax | 502-996-8282
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4350 BROWNSBORO RD STE 210 STE 210
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-1681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-528-2116
-----------------------------------------------------
Fax | 502-996-8282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LAURENCE E FENDRICH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-301-1505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------