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3221 Conway Rd Suite A Orlando FL 32812-7353 | |
| (407) 277-0981 | |
| (407) 277-5513 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 3221 Conway Rd, Orlando, Florida |
| Authorized Official Name and Position | Fay Hempstead Collins (OWNER/PRESIDENT) |
| Authorized Official Contact | 4072770981 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3221 Conway Rd Suite A Orlando FL 32812-7353 Ph: (407) 277-0981 | 3221 Conway Rd Suite A Orlando FL 32812-7353 Ph: (407) 277-0981 |
| NPI Number | 1740676865 |
|---|---|
| Provider Enumeration Date | 04/15/2015 |
| Last Update Date | 04/15/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740676865 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN15637 (Florida) | Secondary |
| 122300000X | Dentist | DN 18832 (Florida) | Primary |
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