Provider Demographics
NPI:1427641935
Name:SDK FAMILY DENTISTRY & ORTHODONTICS, LLC
Entity type:Organization
Organization Name:SDK FAMILY DENTISTRY & ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FABIOLA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:SOPRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-201-3998
Mailing Address - Street 1:2102 E. OSCEOLA PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743
Mailing Address - Country:US
Mailing Address - Phone:407-201-3998
Mailing Address - Fax:407-931-3962
Practice Address - Street 1:2102 E. OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743
Practice Address - Country:US
Practice Address - Phone:407-201-3998
Practice Address - Fax:407-931-3962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty