Provider Demographics
NPI:1083091342
Name:SIMPLE SOLUTIONS ENDODONTICS LLC
Entity Type:Organization
Organization Name:SIMPLE SOLUTIONS ENDODONTICS LLC
Other - Org Name:APOPKA ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-930-4496
Mailing Address - Street 1:660 EXECUTIVE PARK CT STE 1600
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6080
Mailing Address - Country:US
Mailing Address - Phone:407-930-4496
Mailing Address - Fax:407-930-4497
Practice Address - Street 1:660 EXECUTIVE PARK CT STE 1600
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6080
Practice Address - Country:US
Practice Address - Phone:407-930-4496
Practice Address - Fax:407-930-4497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN172561223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023026500Medicaid