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General NPI Number Information
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NPI Number | 1982225132
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Entity Type | Organization
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Legal Business Name | LAKE FOREST ENDODONTICS, PA
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Dates
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Enumeration Date | 04/29/2020
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Last Update Date | 04/29/2020
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Provider Practice Location Address
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Address Line | 5264 W STATE ROAD 46 UNIT C4
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City | SANFORD
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State | FL
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Zip | 32771
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Country | US
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Telephone | 407-577-3636
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Fax | 407-317-4099
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Provider Business Mailing Address
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Address Line | 610 N MILLS AVE STE 210
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City | ORLANDO
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State | FL
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Zip | 32803
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Country | US
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Telephone | 407-423-7667
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Fax | 407-425-8629
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY J TEMPLE
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Credential | DMD
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Telephone | 407-423-7667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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