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General NPI Number Information
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NPI Number | 1649432881
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Entity Type | Organization
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Legal Business Name | COSMETIC AND RESTORATIVE DENTISTRY OF LAKE MARY
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 737 STIRLING CENTER PL SUITE 1011
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City | LAKE MARY
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State | FL
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Zip | 32746-4856
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Country | US
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Telephone | 407-805-8808
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Fax |
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Provider Business Mailing Address
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Address Line | 737 STIRLING CENTER PL SUITE 1011
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City | LAKE MARY
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State | FL
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Zip | 32746-4856
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Country | US
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Telephone | 407-805-8808
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALFREDO M GAPUZ
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Credential | D.M.D.
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Telephone | 407-251-5100
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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 | DN13068
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License Number State | FL
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