Provider Demographics
NPI:1659011948
Name:ADVANTAGE DENTAL ORAL HEALTH CENTER OF FLORIDA PA
Entity Type:Organization
Organization Name:ADVANTAGE DENTAL ORAL HEALTH CENTER OF FLORIDA PA
Other - Org Name:ADVANTAGE DENTAL PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SMANAGER, LICENSING & CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMONDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-999-5014
Mailing Address - Street 1:3322 W END AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-6805
Mailing Address - Country:US
Mailing Address - Phone:629-999-5014
Mailing Address - Fax:
Practice Address - Street 1:99 EGLIN PKWY NE STE 28
Practice Address - Street 2:
Practice Address - City:FT WALTON BCH
Practice Address - State:FL
Practice Address - Zip Code:32548-4284
Practice Address - Country:US
Practice Address - Phone:850-749-6069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty