Provider Demographics
NPI:1154513216
Name:ORLANDO FAMILY DENTAL
Entity type:Organization
Organization Name:ORLANDO FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:CASTANO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MS
Authorized Official - Phone:407-295-9096
Mailing Address - Street 1:3300 S HIAWASSEE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6350
Mailing Address - Country:US
Mailing Address - Phone:407-295-9096
Mailing Address - Fax:407-295-8118
Practice Address - Street 1:3300 S HIAWASSEE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6350
Practice Address - Country:US
Practice Address - Phone:407-295-9096
Practice Address - Fax:407-295-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 14500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty