Provider Demographics
NPI:1629704218
Name:APOPKA MODERN DENTISTRY LLC
Entity Type:Organization
Organization Name:APOPKA MODERN DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NIMISH
Authorized Official - Middle Name:
Authorized Official - Last Name:MANIAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-413-9000
Mailing Address - Street 1:3442 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4602
Mailing Address - Country:US
Mailing Address - Phone:954-701-0871
Mailing Address - Fax:
Practice Address - Street 1:3030 E SEMORAN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5976
Practice Address - Country:US
Practice Address - Phone:407-792-2409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty