Provider Demographics
NPI:1073160487
Name:CENTER FOR INTEGRATIVE ORAL HEALTH INC
Entity Type:Organization
Organization Name:CENTER FOR INTEGRATIVE ORAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAISRI
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOPPAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-664-6999
Mailing Address - Street 1:7151 UNIVERSITY BLVD UNIT 110
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6724
Mailing Address - Country:US
Mailing Address - Phone:407-664-6999
Mailing Address - Fax:
Practice Address - Street 1:7151 UNIVERSITY BLVD UNIT 110
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-6724
Practice Address - Country:US
Practice Address - Phone:407-664-6999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X2210XDental ProvidersDentistOrofacial PainGroup - Multi-Specialty
No125Q00000XDental ProvidersOral MedicinistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLY180OtherMEDICARE PTAN