MEDICARE: ALTAMONTE ORAL & MAXILLOFACIAL SURGERY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223G0001X	General Practice Dentistry
2	1223P0700X	Prosthodontics
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1073460440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTAMONTE ORAL & MAXILLOFACIAL SURGERY LLC

Provider Business Mailing Address
First Line	:	659 MAITLAND AVE
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-6860
Country	:	US
Telephone Number	:	321-246-6027
Fax Number	:

Provider Business Practice Location Address
First Line	:	659 MAITLAND AVE
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-6860
Country	:	US
Telephone Number	:	321-246-6027
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. JUGNU DHAMIJA
Credential	:	DMD
Telephone Number	:	321-246-6027

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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