Provider Demographics
NPI:1215469184
Name:CITRUS DENTAL SLEEP CENTER, LLC
Entity type:Organization
Organization Name:CITRUS DENTAL SLEEP CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:MAGYAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-503-6863
Mailing Address - Street 1:8415 SOUTH SUNCOAST BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446
Mailing Address - Country:US
Mailing Address - Phone:352-503-6863
Mailing Address - Fax:
Practice Address - Street 1:8415 SOUTH SUNCOAST BOULEVARD
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446
Practice Address - Country:US
Practice Address - Phone:352-503-6863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty