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General NPI Number Information
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NPI Number | 1942994488
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Entity Type | Organization
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Legal Business Name | ALTAMONTE SPRINGS DENTAL GROUP PA
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Dates
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Enumeration Date | 06/07/2023
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 1001 N STATE ROAD 434 STE 1010
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-7038
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Country | US
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Telephone | 407-545-5985
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Fax | 407-545-6616
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Provider Business Mailing Address
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Address Line | PO BOX 920050
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City | DALLAS
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State | TX
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Zip | 75392-7038
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DDS
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Name | MINH PHAM
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Credential |
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Telephone | 407-545-5985
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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 |
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License Number State |
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