Provider Demographics
NPI:1174498141
Name:INNOVA DENTAL CARE LLC
Entity type:Organization
Organization Name:INNOVA DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SPERANDIO LOPES MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:862-704-9388
Mailing Address - Street 1:7208 W SAND LAKE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5277
Mailing Address - Country:US
Mailing Address - Phone:321-319-4005
Mailing Address - Fax:321-319-4155
Practice Address - Street 1:7208 W SAND LAKE RD STE 104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5277
Practice Address - Country:US
Practice Address - Phone:321-319-4005
Practice Address - Fax:321-319-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental