Provider Demographics
NPI:1417032566
Name:CITRUS DENTAL ASSOCIATION, P.A.
Entity Type:Organization
Organization Name:CITRUS DENTAL ASSOCIATION, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-726-5854
Mailing Address - Street 1:314 S LINE AVE
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4606
Mailing Address - Country:US
Mailing Address - Phone:352-726-5854
Mailing Address - Fax:352-726-6893
Practice Address - Street 1:314 S LINE AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4606
Practice Address - Country:US
Practice Address - Phone:352-726-5854
Practice Address - Fax:352-726-6893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty