Provider Demographics
NPI:1346368313
Name:COLONIAL DENTAL CARE,INC
Entity Type:Organization
Organization Name:COLONIAL DENTAL CARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:THAI
Authorized Official - Middle Name:K
Authorized Official - Last Name:LA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-299-9099
Mailing Address - Street 1:5074 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-7668
Mailing Address - Country:US
Mailing Address - Phone:407-299-9099
Mailing Address - Fax:407-295-9505
Practice Address - Street 1:5074 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7668
Practice Address - Country:US
Practice Address - Phone:407-299-9099
Practice Address - Fax:407-295-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-174751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty