| Orthodontics Of | |
|
14055 Town Loop Blvd Ste 100 Orlando FL 32837-6105 | |
| (407) 826-0111 | |
| (407) 851-4208 |
| Full Name | Orthodontics Of |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 14055 Town Loop Blvd, Orlando, Florida |
| Authorized Official Name and Position | Maritza Dejesus (PRESIDENT) |
| Authorized Official Contact | 4078260111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Orthodontics Of 14055 Town Loop Blvd Ste 100 Orlando FL 32837-6105 Ph: (407) 826-0111 | Orthodontics Of 14055 Town Loop Blvd Ste 100 Orlando FL 32837-6105 Ph: (407) 826-0111 |
| NPI Number | 1376847046 |
|---|---|
| Provider Enumeration Date | 01/10/2011 |
| Last Update Date | 01/10/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376847046 | NPI | - | NPPES |
| 074375500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | DN13313 (Florida) | Primary |
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