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General NPI Number Information
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NPI Number | 1710281324
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Entity Type | Organization
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Legal Business Name | ARTISTIC SMILES OF ORLANDO
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Dates
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Enumeration Date | 12/23/2010
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Last Update Date | 12/23/2010
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Provider Practice Location Address
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Address Line | 3011 ALOMA AVE
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City | WINTER PARK
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State | FL
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Zip | 32792-3701
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Country | US
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Telephone | 407-678-7874
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Fax |
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Provider Business Mailing Address
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Address Line | 3011 ALOMA AVE
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City | WINTER PARK
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State | FL
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Zip | 32792-3701
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Country | US
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Telephone | 407-678-7874
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JUGNU DHAMIJA
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Credential | DMD
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Telephone | 321-246-6027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN 15961
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License Number State | FL
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