Provider Demographics
NPI:1760861165
Name:FLORIDA FAMILY DENTISTRY ORMOND BEACH
Entity Type:Organization
Organization Name:FLORIDA FAMILY DENTISTRY ORMOND BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOPADRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-672-1980
Mailing Address - Street 1:555 W GRANADA BLVD STE F9
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9405
Mailing Address - Country:US
Mailing Address - Phone:386-672-1980
Mailing Address - Fax:386-673-5339
Practice Address - Street 1:555 W GRANADA BLVD STE F9
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9405
Practice Address - Country:US
Practice Address - Phone:386-672-1980
Practice Address - Fax:386-673-5339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty