Provider Demographics
NPI:1639464852
Name:ORLANDO DENTAL SLEEP MEDICINE INCORPORATED
Entity Type:Organization
Organization Name:ORLANDO DENTAL SLEEP MEDICINE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HODGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-647-1744
Mailing Address - Street 1:1350 ORANGE AVE
Mailing Address - Street 2:#106
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4945
Mailing Address - Country:US
Mailing Address - Phone:407-647-1744
Mailing Address - Fax:407-647-0139
Practice Address - Street 1:1350 ORANGE AVE
Practice Address - Street 2:#106
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4945
Practice Address - Country:US
Practice Address - Phone:407-647-1744
Practice Address - Fax:407-647-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15265122300000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6589750001Medicare NSC