Provider Demographics
NPI:1245783422
Name:COSMETIC & FAMILY DENTISTRY PL
Entity Type:Organization
Organization Name:COSMETIC & FAMILY DENTISTRY PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:C
Authorized Official - Last Name:OBEROI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-352-7700
Mailing Address - Street 1:6900 TURKEY LAKE RD
Mailing Address - Street 2:# 1-9
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4707
Mailing Address - Country:US
Mailing Address - Phone:407-352-7700
Mailing Address - Fax:407-352-7787
Practice Address - Street 1:6900 TURKEY LAKE RD
Practice Address - Street 2:# 1-9
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4707
Practice Address - Country:US
Practice Address - Phone:407-352-7700
Practice Address - Fax:407-352-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14640122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07599450Medicaid