Provider Demographics
NPI:1407116353
Name:ADVANCED DENTAL CARE OF LONGWOOD PL
Entity Type:Organization
Organization Name:ADVANCED DENTAL CARE OF LONGWOOD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-726-1611
Mailing Address - Street 1:505 WEKIVA SPRINGS RD
Mailing Address - Street 2:100
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-6190
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 WEKIVA SPRINGS RD
Practice Address - Street 2:100
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-6190
Practice Address - Country:US
Practice Address - Phone:407-786-2552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty