Provider Demographics
NPI:1104610617
Name:STRIDE DENTAL HUB LLC
Entity type:Organization
Organization Name:STRIDE DENTAL HUB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-529-6814
Mailing Address - Street 1:8154 LAZY BEAR LN
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-9409
Mailing Address - Country:US
Mailing Address - Phone:407-529-6814
Mailing Address - Fax:
Practice Address - Street 1:5030 W STATE ROAD 46 STE 1018
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9247
Practice Address - Country:US
Practice Address - Phone:407-529-6814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STRIDE DENTAL GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-08
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty