|
| |
|
8010 Sunport Dr Ste 115 Orlando FL 32809-7897 | |
| (407) 412-7887 | |
| (407) 930-2758 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 8010 Sunport Dr Ste 115, Orlando, Florida |
| Authorized Official Name and Position | Thida Thana (MANAGER) |
| Authorized Official Contact | 4075428383 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8010 Sunport Dr Ste 115 Orlando FL 32809-7897 Ph: (407) 412-7887 | 8010 Sunport Dr Ste 115 Orlando FL 32809-7897 Ph: (407) 412-7887 |
| NPI Number | 1104311331 |
|---|---|
| Provider Enumeration Date | 06/29/2018 |
| Last Update Date | 04/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104311331 | NPI | - | NPPES |
| 076828600 | Medicaid | FL | |
| 116520600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Florida) | Secondary |
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
Community Health Centers, Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6101 Lake Ellenor Dr, Suite 106, Orlando, FL 32809 Phone: 407-956-4660 Fax: 407-855-8882 | |
Dr Maria's Dental Studio Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 4401 E Colonial Dental, Suite 108, Orlando, FL 32803 Phone: 407-228-2251 | |
Bellasmiles Orthodontics Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 12001 Avalon Lake Dr Ste K, Orlando, FL 32828 Phone: 407-680-3197 | |
Pure Smiles, Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 8185 Lee Vista Blvd Ste 200, Orlando, FL 32829 Phone: 407-881-1751 |