Provider Demographics
NPI:1366632564
Name:WEST ORANGE DENTAL GROUP
Entity Type:Organization
Organization Name:WEST ORANGE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-654-2999
Mailing Address - Street 1:1231 BLACKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4521
Mailing Address - Country:US
Mailing Address - Phone:407-654-2999
Mailing Address - Fax:
Practice Address - Street 1:1231 BLACKWOOD AVE
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4521
Practice Address - Country:US
Practice Address - Phone:407-654-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN84471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty