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General NPI Number Information
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NPI Number | 1619388758
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Entity Type | Organization
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Legal Business Name | MAITLAND ORTHODONTIC SPECIALISTS
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 320 N MAITLAND AVE
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City | MAITLAND
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State | FL
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Zip | 32751-4772
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Country | US
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Telephone | 407-699-1102
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Fax | 407-699-4327
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Provider Business Mailing Address
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Address Line | 320 N MAITLAND AVE
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City | MAITLAND
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State | FL
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Zip | 32751-4772
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Country | US
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Telephone | 407-699-1102
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Fax | 407-699-4327
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TRAVIS A WEEKS
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Credential | D.D.S.
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Telephone | 407-699-1102
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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 | FL
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