| Main Street Childrens Dentistry And Orthodontics Waterford Lakes Pllc | |
|
12150 Lake Underhill Rd Orlando FL 32825-5012 | |
| (321) 319-7027 | |
| Not Available |
| Full Name | Main Street Childrens Dentistry And Orthodontics Waterford Lakes Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 12150 Lake Underhill Rd, Orlando, Florida |
| Authorized Official Name and Position | Stephanie Gomez (CREDENTIALING SUPERVISOR) |
| Authorized Official Contact | 3052742499 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Childrens Dentistry And Orthodontics Waterford Lakes Pllc 12150 Lake Underhill Rd Orlando FL 32825-5012 Ph: () - | Main Street Childrens Dentistry And Orthodontics Waterford Lakes Pllc 12150 Lake Underhill Rd Orlando FL 32825-5012 Ph: (321) 319-7027 |
| NPI Number | 1881161297 |
|---|---|
| Provider Enumeration Date | 10/24/2018 |
| Last Update Date | 10/24/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881161297 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Secondary |
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