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1221 W Fairbanks Ave Orlando FL 32804-1205 | |
| (407) 628-9091 | |
| (407) 256-4040 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1221 W Fairbanks Ave, Orlando, Florida |
| Authorized Official Name and Position | Pam Hardiek (INSURANCE/CREDENTIALING) |
| Authorized Official Contact | 2175405100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1221 W Fairbanks Ave Orlando FL 32804-1205 Ph: (407) 628-9091 | 1221 W Fairbanks Ave Orlando FL 32804-1205 Ph: (407) 628-9091 |
| NPI Number | 1386922235 |
|---|---|
| Provider Enumeration Date | 07/26/2011 |
| Last Update Date | 07/26/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386922235 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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