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7848 Winter Garden Vineland Rd 100 Windermere FL 34786-5934 | |
| (407) 810-8271 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 7848 Winter Garden Vineland Rd, Windermere, Florida |
| Authorized Official Name and Position | Lauris Johnson (OWNER) |
| Authorized Official Contact | 4078108271 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
7848 Winter Garden Vineland Rd 100 Windermere FL 34786-5934 Ph: () - | 7848 Winter Garden Vineland Rd 100 Windermere FL 34786-5934 Ph: (407) 810-8271 |
| NPI Number | 1295279925 |
|---|---|
| Provider Enumeration Date | 12/15/2016 |
| Last Update Date | 12/15/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295279925 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 16876 (Florida) | Primary |
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