Provider Demographics
NPI:1790195709
Name:HALLMARK DENTAL LLC
Entity Type:Organization
Organization Name:HALLMARK DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLMOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-344-2400
Mailing Address - Street 1:1014 BUENAVENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-7865
Mailing Address - Country:US
Mailing Address - Phone:407-344-2400
Mailing Address - Fax:407-344-1728
Practice Address - Street 1:1014 BUENAVENTURA BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-7865
Practice Address - Country:US
Practice Address - Phone:407-344-2400
Practice Address - Fax:407-344-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty