Provider Demographics
NPI:1740782408
Name:ADVANCED ESTHETIC DENTISTRY, PA
Entity Type:Organization
Organization Name:ADVANCED ESTHETIC DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:TANNER
Authorized Official - Last Name:ENFINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-352-6001
Mailing Address - Street 1:6001 VINELAND RD STE 119
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7829
Mailing Address - Country:US
Mailing Address - Phone:407-352-6001
Mailing Address - Fax:407-351-6001
Practice Address - Street 1:6001 VINELAND RD STE 119
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7829
Practice Address - Country:US
Practice Address - Phone:407-352-6001
Practice Address - Fax:407-351-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16710261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental