MEDICARE: HOLDEN 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	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730200627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLDEN DENTAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	4638 S ORANGE BLOSSOM TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-1706
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4638 S ORANGE BLOSSOM TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-1706
Country	:	US
Telephone Number	:	407-858-0321
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. IVAN GRAHAM
Credential	:
Telephone Number	:	407-858-0321

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	05/05/2008

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