Provider Demographics
NPI:1194115956
Name:DR AFSOON ELMORE DDS PLC
Entity type:Organization
Organization Name:DR AFSOON ELMORE DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSOON
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-629-6464
Mailing Address - Street 1:668 N ORLANDO AVE
Mailing Address - Street 2:SUITE1008
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4473
Mailing Address - Country:US
Mailing Address - Phone:407-629-6464
Mailing Address - Fax:407-629-0031
Practice Address - Street 1:668 N ORLANDO AVE
Practice Address - Street 2:SUITE1008
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4473
Practice Address - Country:US
Practice Address - Phone:407-629-6464
Practice Address - Fax:407-629-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16958261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075545100Medicaid