Provider Demographics
NPI:1164712881
Name:CITRUS DENTAL OF INVERNESS, P.A.
Entity Type:Organization
Organization Name:CITRUS DENTAL OF INVERNESS, P.A.
Other - Org Name:CITRUS DENTAL ASSOCIATION, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-726-5854
Mailing Address - Street 1:2231 HIGHWAY 44 W
Mailing Address - Street 2:UNIT 101
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-3879
Mailing Address - Country:US
Mailing Address - Phone:352-726-5854
Mailing Address - Fax:352-726-6893
Practice Address - Street 1:2231 HIGHWAY 44 W
Practice Address - Street 2:UNIT 101
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3879
Practice Address - Country:US
Practice Address - Phone:352-726-5854
Practice Address - Fax:352-726-6893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL57311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty