Provider Demographics
NPI:1316391170
Name:INFINITY DENTAL LLC
Entity type:Organization
Organization Name:INFINITY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS , PA
Authorized Official - Phone:407-814-4940
Mailing Address - Street 1:1450 N. ROCK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712
Mailing Address - Country:US
Mailing Address - Phone:407-814-4940
Mailing Address - Fax:
Practice Address - Street 1:1450 N. ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712
Practice Address - Country:US
Practice Address - Phone:407-814-4940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001037900Medicaid