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General NPI Number Information
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NPI Number | 1689711905
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Entity Type | Organization
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Legal Business Name | GATOR DENTAL ASSOCIATES, PA
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6605 SE 221ST ST
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City | HAWTHORNE
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State | FL
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Zip | 32640-3815
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Country | US
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Telephone | 352-481-2741
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Fax | 352-481-5341
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | HAWTHORNE
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State | FL
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Zip | 32640-0010
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Country | US
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Telephone | 352-481-2741
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Fax | 352-481-5341
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY H GARLITZ
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Credential | D.M.D.
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Telephone | 352-481-2741
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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 | DN 9207
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License Number State | FL
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