Provider Demographics
NPI:1003947326
Name:PLATINUM DENTAL GROUP PA
Entity Type:Organization
Organization Name:PLATINUM DENTAL GROUP PA
Other - Org Name:CELEBRATION DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUZYAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-566-2222
Mailing Address - Street 1:741 FRONT ST
Mailing Address - Street 2:#310
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4991
Mailing Address - Country:US
Mailing Address - Phone:407-566-2222
Mailing Address - Fax:407-566-1650
Practice Address - Street 1:400 CELEBRATION PL
Practice Address - Street 2:A-260
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4970
Practice Address - Country:US
Practice Address - Phone:407-566-2222
Practice Address - Fax:407-566-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty