Provider Demographics
NPI:1285801381
Name:ORAL & MAXILLOFACIAL SURGEONS OF MID-FLORIDA
Entity type:Organization
Organization Name:ORAL & MAXILLOFACIAL SURGEONS OF MID-FLORIDA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARFINKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-774-3399
Mailing Address - Street 1:1573 W FAIRBANKS AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4679
Mailing Address - Country:US
Mailing Address - Phone:407-644-0224
Mailing Address - Fax:407-644-2827
Practice Address - Street 1:195 BRIAR CLIFF DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4443
Practice Address - Country:US
Practice Address - Phone:407-774-3399
Practice Address - Fax:407-774-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77201AMedicare PIN