Provider Demographics
NPI:1396060430
Name:ORLANDO ENDODONTIC SPECIALISTS-EAST
Entity type:Organization
Organization Name:ORLANDO ENDODONTIC SPECIALISTS-EAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-581-9505
Mailing Address - Street 1:610 N MILLS AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-7119
Mailing Address - Country:US
Mailing Address - Phone:407-423-7667
Mailing Address - Fax:407-425-8629
Practice Address - Street 1:12301 LAKE UNDERHILL RD
Practice Address - Street 2:STE 107
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4508
Practice Address - Country:US
Practice Address - Phone:407-581-9515
Practice Address - Fax:407-581-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN143841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty