Provider Demographics
NPI:1215208707
Name:VDC-SPRING HILL PA
Entity Type:Organization
Organization Name:VDC-SPRING HILL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-684-1274
Mailing Address - Street 1:7357 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4300
Mailing Address - Country:US
Mailing Address - Phone:352-684-1274
Mailing Address - Fax:352-263-2756
Practice Address - Street 1:7357 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4300
Practice Address - Country:US
Practice Address - Phone:352-684-1274
Practice Address - Fax:352-263-2756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN71621223G0001X
FLDN175671223G0001X
FLDN170811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty