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701 W Livingston St Bldg 800 Orlando FL 32805-1560 | |
| (407) 428-5751 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 701 W Livingston St Bldg 800, Orlando, Florida |
| Authorized Official Name and Position | Bakari F Burns (PRESIDENT/CEO) |
| Authorized Official Contact | 4074285751 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
232 N Orange Blossom Trl Orlando FL 32805-1612 Ph: (407) 428-5751 | 701 W Livingston St Bldg 800 Orlando FL 32805-1560 Ph: (407) 428-5751 |
| NPI Number | 1467953083 |
|---|---|
| Provider Enumeration Date | 02/28/2018 |
| Last Update Date | 02/28/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467953083 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary |
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