Provider Demographics
NPI:1356077499
Name:LTC DENTAL PC
Entity Type:Organization
Organization Name:LTC DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FOY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-375-3003
Mailing Address - Street 1:1257 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4816
Mailing Address - Country:US
Mailing Address - Phone:407-375-3003
Mailing Address - Fax:
Practice Address - Street 1:2910 MINNEHAHA CURV
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-2528
Practice Address - Country:US
Practice Address - Phone:407-375-3003
Practice Address - Fax:800-863-5373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty