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General NPI Number Information
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NPI Number | 1659638484
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Entity Type | Organization
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Legal Business Name | ORLANDO ENDODONTIC SPECIALISTS SOUTH
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 610 N MILLS AVE 210
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City | ORLANDO
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State | FL
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Zip | 32803-7119
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Country | US
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Telephone | 407-423-7667
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Fax |
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Provider Business Mailing Address
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Address Line | 1956 E OSCEOLA PKWY
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City | KISSIMMEE
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State | FL
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Zip | 34743-8626
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Country | US
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Telephone | 407-581-9500
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Fax |
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Authorized Official
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Title or Position | INSURANCE FRONT DESK
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Name | MARIE DIAZ
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Credential |
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Telephone | 407-423-7667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN14384
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License Number State | FL
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