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General NPI Number Information
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NPI Number | 1881143089
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Entity Type | Organization
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Legal Business Name | ORLANDO DENTIST AND DENTURE LAB LLC
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Dates
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Enumeration Date | 09/28/2016
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 4929 S ORANGE AVE
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City | ORLANDO
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State | FL
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Zip | 32806-6932
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Country | US
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Telephone | 407-605-5624
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Fax | 407-289-4098
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Provider Business Mailing Address
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Address Line | 4929 S ORANGE AVE
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City | ORLANDO
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State | FL
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Zip | 32806-6932
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Country | US
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Telephone | 407-605-5624
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Fax | 407-289-4098
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. PAUL SZOTT
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Credential | D.M.D.
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Telephone | 407-605-5426
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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 | BS5332957
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License Number State | FL
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