Provider Demographics
NPI:1285139527
Name:L&L BEVILLE DENTAL LLC
Entity type:Organization
Organization Name:L&L BEVILLE DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZDENEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-761-2273
Mailing Address - Street 1:911 BEVILLE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1726
Mailing Address - Country:US
Mailing Address - Phone:386-761-2273
Mailing Address - Fax:407-386-9000
Practice Address - Street 1:911 BEVILLE ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3211
Practice Address - Country:US
Practice Address - Phone:386-761-2273
Practice Address - Fax:407-386-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN7283261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID NUMBER