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General NPI Number Information
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NPI Number | 1770423410
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Entity Type | Organization
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Legal Business Name | BRYAN D. OETH,DMD,COSMETIC & RESTORATIVE DENTAL CARE OF LAKE MARY, FL, PA
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 737 STIRLING CENTER PL STE 1801
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City | LAKE MARY
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State | FL
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Zip | 32746-5715
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Country | US
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Telephone | 407-805-8808
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Fax | 407-805-8905
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Provider Business Mailing Address
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Address Line | 737 STIRLING CENTER PL STE 1801
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City | LAKE MARY
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State | FL
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Zip | 32746-5715
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Country | US
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Telephone | 407-805-8808
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Fax | 407-805-8905
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Authorized Official
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Title or Position | DENTIST/VICE PRESIDENT
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Name | PETER IBRAHIM
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Credential | DMD
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Telephone | 321-276-8465
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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 |
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License Number State |
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