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General NPI Number Information
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NPI Number | 1770003782
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Entity Type | Organization
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Legal Business Name | LAKE EOLA DENTAL, INC.
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 338 N MAGNOLIA AVE STE C
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City | ORLANDO
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State | FL
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Zip | 32801-1639
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Country | US
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Telephone | 407-930-7007
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Fax | 407-930-5410
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Provider Business Mailing Address
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Address Line | 338 N MAGNOLIA AVE STE C
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City | ORLANDO
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State | FL
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Zip | 32801-1639
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Country | US
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Telephone | 407-930-7007
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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. HOANG HO
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Credential | DMD
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Telephone | 804-687-2817
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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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