Provider Demographics
NPI:1235537036
Name:ORLANDO FRIENDLY DENTISTSRY
Entity Type:Organization
Organization Name:ORLANDO FRIENDLY DENTISTSRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-826-1234
Mailing Address - Street 1:7602 W SAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5112
Mailing Address - Country:US
Mailing Address - Phone:407-826-1234
Mailing Address - Fax:407-730-4629
Practice Address - Street 1:7602 W SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5112
Practice Address - Country:US
Practice Address - Phone:407-826-1234
Practice Address - Fax:407-730-4629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14789261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental