Provider Demographics
NPI:1598171720
Name:ASPEN DENTAL
Entity Type:Organization
Organization Name:ASPEN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:BORDELON
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-298-0673
Mailing Address - Street 1:8036 SW 72ND PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8421
Mailing Address - Country:US
Mailing Address - Phone:337-298-0673
Mailing Address - Fax:352-505-3213
Practice Address - Street 1:3411 SW 36TH TER
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7404
Practice Address - Country:US
Practice Address - Phone:352-433-0715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN207691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty