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General NPI Number Information
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NPI Number | 1801912233
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA DENTAL GROUP, INC.
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 07/25/2011
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Provider Practice Location Address
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Address Line | 16215 STATE ROAD 50 STE 102
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City | CLERMONT
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State | FL
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Zip | 34711-6019
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Country | US
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Telephone | 407-654-4024
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Fax | 407-654-4027
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Provider Business Mailing Address
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Address Line | 16215 STATE ROAD 50 STE 102
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City | CLERMONT
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State | FL
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Zip | 34711-6019
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Country | US
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Telephone | 407-654-4024
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Fax | 407-654-4027
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARLOS RODOLFO ORTIZ
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Credential | DDS
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Telephone | 407-654-4024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN16410
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License Number State | FL
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