Provider Demographics
NPI:1992529861
Name:BUENA VISTA FAMILY DENTISTRY
Entity type:Organization
Organization Name:BUENA VISTA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:XIMENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDEA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-748-8290
Mailing Address - Street 1:11444 S APOPKA VINELAND RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-7009
Mailing Address - Country:US
Mailing Address - Phone:407-930-0060
Mailing Address - Fax:407-955-4888
Practice Address - Street 1:11444 S APOPKA VINELAND RD UNIT 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-7009
Practice Address - Country:US
Practice Address - Phone:407-930-0060
Practice Address - Fax:407-955-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental