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8010 Sunport Dr Ste 115 Orlando FL 32809-7897 | |
| (407) 412-7887 | |
| (407) 641-8932 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 8010 Sunport Dr Ste 115, Orlando, Florida |
| Authorized Official Name and Position | Sirin Thanasasavat (PRESIDENT) |
| Authorized Official Contact | 4079297095 |
| 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 | 1144576737 |
|---|---|
| Provider Enumeration Date | 08/01/2012 |
| Last Update Date | 08/01/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144576737 | NPI | - | NPPES |
| 076828600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN17989 (Florida) | Primary |
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