Provider Demographics
NPI:1083325583
Name:MARK DREYER, D.M.D. P.A.
Entity Type:Organization
Organization Name:MARK DREYER, D.M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN/TEAM SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAKULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-713-5785
Mailing Address - Street 1:909 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5029
Mailing Address - Country:US
Mailing Address - Phone:407-933-0885
Mailing Address - Fax:407-933-0520
Practice Address - Street 1:909 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5029
Practice Address - Country:US
Practice Address - Phone:407-933-0885
Practice Address - Fax:407-933-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental