Provider Demographics
NPI:1326535279
Name:CITRUS ORAL AND FACIAL SURGERY AT OCALA, LLC
Entity Type:Organization
Organization Name:CITRUS ORAL AND FACIAL SURGERY AT OCALA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BLOMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:522-509-6500
Mailing Address - Street 1:2611 SE 17TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5587
Mailing Address - Country:US
Mailing Address - Phone:352-509-6500
Mailing Address - Fax:352-509-6556
Practice Address - Street 1:6129 W CORPORATE OAKS DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-8732
Practice Address - Country:US
Practice Address - Phone:352-795-4994
Practice Address - Fax:352-795-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN177081223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty