Provider Demographics
NPI:1417968686
Name:DALE A ROLANDO DMD AND SUE E ROLANDO DMD PA
Entity Type:Organization
Organization Name:DALE A ROLANDO DMD AND SUE E ROLANDO DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:SUE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:ROLANDO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-898-7401
Mailing Address - Street 1:4396 LAKE UNDERHILL RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803
Mailing Address - Country:US
Mailing Address - Phone:407-898-7401
Mailing Address - Fax:407-898-7030
Practice Address - Street 1:4396 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803
Practice Address - Country:US
Practice Address - Phone:407-898-7401
Practice Address - Fax:407-898-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN101431223G0001X
FLDN101441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty