Provider Demographics
NPI:1588878441
Name:ORAL SURGERY CENTER OF WEST ORLANDO
Entity type:Organization
Organization Name:ORAL SURGERY CENTER OF WEST ORLANDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRICENO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-656-9455
Mailing Address - Street 1:12200 W COLONIAL DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4125
Mailing Address - Country:US
Mailing Address - Phone:407-656-9455
Mailing Address - Fax:407-656-6145
Practice Address - Street 1:12200 W COLONIAL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4125
Practice Address - Country:US
Practice Address - Phone:407-656-9455
Practice Address - Fax:407-656-6145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL07-000044921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty