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12014 E Colonial Dr Suite 130 Orlando FL 32826-4750 | |
| (407) 493-0975 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 12014 E Colonial Dr, Orlando, Florida |
| Authorized Official Name and Position | Nguyen V. Nguyen (PRESIDENT) |
| Authorized Official Contact | 4074930975 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2640 Windsorgate Ln Orlando FL 32828-7957 Ph: (407) 493-0977 | 12014 E Colonial Dr Suite 130 Orlando FL 32826-4750 Ph: (407) 493-0975 |
| NPI Number | 1639593817 |
|---|---|
| Provider Enumeration Date | 02/09/2014 |
| Last Update Date | 02/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639593817 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 18897 (Florida) | Primary |
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