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7051 Dr Phillips Blvd Ste 10 Orlando FL 32819-5140 | |
| (407) 345-1442 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 7051 Dr Phillips Blvd Ste 10, Orlando, Florida |
| Authorized Official Name and Position | Anne Thao Nguyen (OWNER) |
| Authorized Official Contact | 4084552471 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
125 Ridgewood Dr Longwood FL 32779-3312 Ph: (408) 455-2471 | 7051 Dr Phillips Blvd Ste 10 Orlando FL 32819-5140 Ph: (407) 345-1442 |
| NPI Number | 1255832440 |
|---|---|
| Provider Enumeration Date | 02/23/2018 |
| Last Update Date | 02/23/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255832440 | NPI | - | NPPES |
| 572237939 | Other | PASSPORT | |
| N250058777110 | Other | FL | FLORIDA DRIVERS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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