MEDICARE: ALTAMONTE DENTAL ASSOCIATES, INC

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	8741	FL

General Provider Information

NPI Number	:	1285836916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTAMONTE DENTAL ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	195 S WESTMONTE DR STE 1112
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-4219
Country	:	US
Telephone Number	:	407-774-8834
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 S WESTMONTE DR STE 1112
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-4219
Country	:	US
Telephone Number	:	407-774-8834
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FERNANDO OLIVER
Credential	:	DMD
Telephone Number	:	407-774-8834

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	08/22/2020

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