Provider Demographics
NPI:1033533203
Name:ENDODONTIC ASSOCIATES OF ORLANDO, P.A.
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATES OF ORLANDO, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANG
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-543-6782
Mailing Address - Street 1:8773 TALLY HO LN
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4541
Mailing Address - Country:US
Mailing Address - Phone:561-543-6782
Mailing Address - Fax:
Practice Address - Street 1:2001 LEE RD STE A
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1871
Practice Address - Country:US
Practice Address - Phone:407-647-2131
Practice Address - Fax:407-645-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-09
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN158911223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty