Provider Demographics
NPI:1417387556
Name:ATA DENTAL DESIGN LLC
Entity Type:Organization
Organization Name:ATA DENTAL DESIGN LLC
Other - Org Name:ATA DENTAL DESIGN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:ATA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-857-6501
Mailing Address - Street 1:13512 S. JOHN YOUNG PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7659
Mailing Address - Country:US
Mailing Address - Phone:407-857-6501
Mailing Address - Fax:863-638-6935
Practice Address - Street 1:13512 S. JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7659
Practice Address - Country:US
Practice Address - Phone:407-857-6501
Practice Address - Fax:863-638-6935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18559122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty