Provider Demographics
NPI:1669503264
Name:ADVANCED DENTAL INC.
Entity Type:Organization
Organization Name:ADVANCED DENTAL INC.
Other - Org Name:ADVANCED DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:O
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:386-322-7786
Mailing Address - Street 1:1525 HERBERT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-6106
Mailing Address - Country:US
Mailing Address - Phone:386-322-7786
Mailing Address - Fax:386-761-3920
Practice Address - Street 1:1525 HERBERT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-6106
Practice Address - Country:US
Practice Address - Phone:386-322-7786
Practice Address - Fax:386-761-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty