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General NPI Number Information
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NPI Number | 1942410246
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Entity Type | Organization
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Legal Business Name | ORAL & MAXILLOFACIAL SURGEONS OF MID-FLORIDA, PA
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 1100 LUCERNE TER STE 100
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City | ORLANDO
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State | FL
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Zip | 32806-1050
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Country | US
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Telephone | 407-843-1670
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Fax | 407-841-1827
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Provider Business Mailing Address
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Address Line | 195 BRIAR CLIFF DR STE 101
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City | LONGWOOD
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State | FL
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Zip | 32779-4443
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Country | US
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Telephone | 407-774-3399
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Fax | 407-774-4322
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY L BEATTIE
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Credential | D.M.D.
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Telephone | 407-774-3399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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