Provider Demographics
NPI:1629751375
Name:OAKLAND PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:OAKLAND PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALMIR
Authorized Official - Middle Name:BALDOCCHI
Authorized Official - Last Name:DA COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-333-0070
Mailing Address - Street 1:273 SAGECREST DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4628
Mailing Address - Country:US
Mailing Address - Phone:352-333-0070
Mailing Address - Fax:
Practice Address - Street 1:15650 W COLONIAL DR STE 200
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9727
Practice Address - Country:US
Practice Address - Phone:352-333-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty