Provider Demographics
NPI:1316627938
Name:REFRESH DENTAL LOUNGE GROUP LLC
Entity type:Organization
Organization Name:REFRESH DENTAL LOUNGE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONSTANTINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-644-7703
Mailing Address - Street 1:185 N LAKEMONT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3203
Mailing Address - Country:US
Mailing Address - Phone:407-644-7703
Mailing Address - Fax:407-644-7703
Practice Address - Street 1:520 EAST CHURCH ST.
Practice Address - Street 2:SUITE 102A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801
Practice Address - Country:US
Practice Address - Phone:407-794-9459
Practice Address - Fax:407-794-9459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty