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General NPI Number Information
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NPI Number | 1558766097
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Entity Type | Organization
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Legal Business Name | ORANGE GROVE DENTAL
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 4122 ROWAN RD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34653-6122
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Country | US
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Telephone | 302-290-2133
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Fax |
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Provider Business Mailing Address
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Address Line | 17039 HEART OF PALMS DR
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City | TAMPA
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State | FL
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Zip | 33647-3508
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MANU MOHAN SACHDEV
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Credential |
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Telephone | 302-290-2133
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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 | DN18942
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License Number State | FL
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