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General NPI Number Information
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NPI Number | 1598171720
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Entity Type | Organization
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Legal Business Name | ASPEN DENTAL
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 3411 SW 36TH TER
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City | OCALA
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State | FL
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Zip | 34474-7404
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Country | US
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Telephone | 352-433-0715
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Fax |
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Provider Business Mailing Address
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Address Line | 8036 SW 72ND PL
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City | GAINESVILLE
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State | FL
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Zip | 32608-8421
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Country | US
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Telephone | 337-298-0673
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Fax | 352-505-3213
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. MOLLY BORDELON STANFORD
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Credential |
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Telephone | 337-298-0673
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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 | DN20769
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License Number State | FL
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