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4098 Libra Dr Orlando FL 32816-3333 | |
| (407) 823-6000 | |
| (407) 823-2099 |
| Full Name | |
|---|---|
| Speciality | Student In An Organized Health Care Education/training Program |
| Location | 4098 Libra Dr, Orlando, Florida |
| Authorized Official Name and Position | Michael G Deichen (DIRECTOR) |
| Authorized Official Contact | 4078236000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 163333 Orlando FL 32816-3333 Ph: (407) 823-6000 | 4098 Libra Dr Orlando FL 32816-3333 Ph: (407) 823-6000 |
| NPI Number | 1689877748 |
|---|---|
| Provider Enumeration Date | 06/07/2007 |
| Last Update Date | 04/19/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689877748 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
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