Provider Demographics
NPI:1033562871
Name:GRAND OAKS DENTAL CARE
Entity Type:Organization
Organization Name:GRAND OAKS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-877-4926
Mailing Address - Street 1:2575 SW 42ND ST
Mailing Address - Street 2:SUITE 104-105
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1355
Mailing Address - Country:US
Mailing Address - Phone:352-877-4926
Mailing Address - Fax:352-224-6154
Practice Address - Street 1:2575 SW 42ND ST
Practice Address - Street 2:SUITE 104-105
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1355
Practice Address - Country:US
Practice Address - Phone:352-877-4926
Practice Address - Fax:352-224-6154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-17
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN162671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty