Provider Demographics
NPI:1508206723
Name:PARADISE DENTAL OF ORLANDO LLC
Entity Type:Organization
Organization Name:PARADISE DENTAL OF ORLANDO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REP
Authorized Official - Prefix:MR
Authorized Official - First Name:GUS
Authorized Official - Middle Name:
Authorized Official - Last Name:KALOTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-370-4600
Mailing Address - Street 1:8351 S JOHN YOUNG PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8351 S JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9037
Practice Address - Country:US
Practice Address - Phone:407-370-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty