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General NPI Number Information
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NPI Number | 1609632082
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Entity Type | Organization
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Legal Business Name | CHILDREN AND TEEN ORTHO GROUP OF FLORIDA
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Dates
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Enumeration Date | 02/23/2024
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 3885 S FLORIDA AVE
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City | LAKELAND
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State | FL
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Zip | 33813-1109
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Country | US
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Telephone | 863-333-0397
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 LAKEVIEW PKWY STE 250
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City | ALPHARETTA
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State | GA
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Zip | 30009-3954
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Country | US
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Telephone | 470-207-3264
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Fax |
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Authorized Official
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Title or Position | CHIEF OFFICER
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Name | BRIAN SMITH
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Credential |
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Telephone | 770-231-5348
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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 |
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License Number State |
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