Provider Demographics
NPI:1215200084
Name:ORANGE AVENUE DENTISTRY, INC.
Entity Type:Organization
Organization Name:ORANGE AVENUE DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:NAGUIB
Authorized Official - Last Name:YOUSSEF
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-426-9933
Mailing Address - Street 1:2116 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-3037
Mailing Address - Country:US
Mailing Address - Phone:407-426-9933
Mailing Address - Fax:407-426-9032
Practice Address - Street 1:2116 S. ORANGE AVE.
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:407-426-9933
Practice Address - Fax:407-426-9032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16092305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003787800Medicaid