Provider Demographics
NPI:1346806627
Name:PLANES DENTAL ARTS LAKE NONA
Entity type:Organization
Organization Name:PLANES DENTAL ARTS LAKE NONA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:A
Authorized Official - Last Name:PLANES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:772-231-6004
Mailing Address - Street 1:10157 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5609
Mailing Address - Country:US
Mailing Address - Phone:772-337-1127
Mailing Address - Fax:772-337-1121
Practice Address - Street 1:9436 NARCOOSSEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-5705
Practice Address - Country:US
Practice Address - Phone:772-337-1127
Practice Address - Fax:772-337-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-13
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN20254OtherGENERAL DENTISTRY