Provider Demographics
NPI:1306230545
Name:ORAL SURGERY ASSOCIATES OF CENTRAL FLORIDA, PA
Entity Type:Organization
Organization Name:ORAL SURGERY ASSOCIATES OF CENTRAL FLORIDA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:POWELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-294-3300
Mailing Address - Street 1:7651 ASHLEY PARK CT
Mailing Address - Street 2:SUITE 406B
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6114
Mailing Address - Country:US
Mailing Address - Phone:407-294-3300
Mailing Address - Fax:407-297-7417
Practice Address - Street 1:7651 ASHLEY PARK CT
Practice Address - Street 2:SUITE 406B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6114
Practice Address - Country:US
Practice Address - Phone:407-294-3300
Practice Address - Fax:407-297-7417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11672261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL074705000Medicaid