Provider Demographics
NPI:1437432713
Name:SPECIALTY SCANNING LLC
Entity Type:Organization
Organization Name:SPECIALTY SCANNING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONIDES
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-654-8211
Mailing Address - Street 1:13640 W COLONIAL DR
Mailing Address - Street 2:SUITE 190
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3992
Mailing Address - Country:US
Mailing Address - Phone:407-654-8211
Mailing Address - Fax:407-654-6806
Practice Address - Street 1:13640 W COLONIAL DR
Practice Address - Street 2:SUITE 190
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3992
Practice Address - Country:US
Practice Address - Phone:407-654-8211
Practice Address - Fax:407-654-6806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13000261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental