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General NPI Number Information
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NPI Number | 1821259383
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Entity Type | Organization
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Legal Business Name | CLASSIC DENTAL, INC.
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 4267 W LAKE MARY BLVD
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City | LAKE MARY
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State | FL
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Zip | 32746-2411
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Country | US
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Telephone | 407-302-7774
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Fax | 407-302-5651
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Provider Business Mailing Address
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Address Line | 4267 W LAKE MARY BLVD
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City | LAKE MARY
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State | FL
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Zip | 32746-2411
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Country | US
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Telephone | 407-302-7774
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Fax | 407-302-5651
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Authorized Official
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Title or Position | OWNER
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Name | DR. CEASAR M. GARCIA
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Credential | D.M.D.
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Telephone | 407-302-7774
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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 | DN11075
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License Number State | FL
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