MEDICARE: SOUTH ORLANDO DENTAL PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN6106	FL

General Provider Information

NPI Number	:	1205955853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH ORLANDO DENTAL PA

Provider Business Mailing Address
First Line	:	7221 CHANCERY LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7039
Country	:	US
Telephone Number	:	407-855-0474
Fax Number	:	407-855-0197

Provider Business Practice Location Address
First Line	:	7221 CHANCERY LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7039
Country	:	US
Telephone Number	:	407-855-0474
Fax Number	:	407-855-0197

Authorized Official
Title or Position	:	DENTAL DIRECTOR
Name	:	DR. KENNETH E PYLE
Credential	:	DDS
Telephone Number	:	407-330-3801

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	08/22/2020

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Directions to “SOUTH ORLANDO DENTAL PA ” Practice Location

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