Provider Demographics
NPI:1467672741
Name:DORSEY, T. J SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:T.
Middle Name:J
Last Name:DORSEY
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-2668
Mailing Address - Country:US
Mailing Address - Phone:407-423-8546
Mailing Address - Fax:
Practice Address - Street 1:708 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-2668
Practice Address - Country:US
Practice Address - Phone:407-423-8546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL51011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice