Provider Demographics
NPI:1316759327
Name:CELEBRATION PEDIATRIC DENTISTRY, PA
Entity type:Organization
Organization Name:CELEBRATION PEDIATRIC DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-247-8219
Mailing Address - Street 1:1530 CELEBRATION BLVD STE 411
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5165
Mailing Address - Country:US
Mailing Address - Phone:407-247-8219
Mailing Address - Fax:
Practice Address - Street 1:1530 CELEBRATION BLVD STE 411
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5165
Practice Address - Country:US
Practice Address - Phone:407-247-8219
Practice Address - Fax:407-566-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty