Provider Demographics
NPI:1699009688
Name:CAROLINA DENTURES OF THE VILLAGES
Entity type:Organization
Organization Name:CAROLINA DENTURES OF THE VILLAGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MASTAPASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-674-9077
Mailing Address - Street 1:8640 E COUNTY ROAD 466
Mailing Address - Street 2:SUITE B
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5615
Mailing Address - Country:US
Mailing Address - Phone:352-674-9077
Mailing Address - Fax:352-259-8542
Practice Address - Street 1:8640 E COUNTY ROAD 466
Practice Address - Street 2:SUITE B
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5615
Practice Address - Country:US
Practice Address - Phone:352-674-9077
Practice Address - Fax:352-259-8542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0011269261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental