Provider Demographics
NPI:1003110115
Name:CITY HALL DENTAL PL
Entity Type:Organization
Organization Name:CITY HALL DENTAL PL
Other - Org Name:DR PHILLIPS DENTAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLA ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-351-5691
Mailing Address - Street 1:7932 W SAND LAKE RD
Mailing Address - Street 2:STE 105
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7263
Mailing Address - Country:US
Mailing Address - Phone:407-351-5691
Mailing Address - Fax:
Practice Address - Street 1:3311 DANIELS RD
Practice Address - Street 2:STE 104
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-7000
Practice Address - Country:US
Practice Address - Phone:407-656-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHAMPION ORTHODONTICS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN164461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DN16446OtherDENTAL LICENSE STATE OF FLORIDA