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General NPI Number Information
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NPI Number | 1629704218
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Entity Type | Organization
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Legal Business Name | APOPKA MODERN DENTISTRY LLC
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 3030 E SEMORAN BLVD STE 200
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City | APOPKA
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State | FL
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Zip | 32703-5976
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Country | US
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Telephone | 407-792-2409
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Fax |
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Provider Business Mailing Address
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Address Line | 3442 MICHIGAN ST
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City | LAKE MARY
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State | FL
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Zip | 32746-4602
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Country | US
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Telephone | 954-701-0871
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. NIMISH MANIAR
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Credential | DMD
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Telephone | 407-413-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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