Provider Demographics
NPI:1790933554
Name:SIGMA DENTAL OF KISSIMMEE, LLC
Entity Type:Organization
Organization Name:SIGMA DENTAL OF KISSIMMEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:FABIOLA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:SOPRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-451-5866
Mailing Address - Street 1:2102 E OSCEOLA PKWY
Mailing Address - Street 2:SUITES 2102-2104
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-8630
Mailing Address - Country:US
Mailing Address - Phone:407-201-3998
Mailing Address - Fax:407-931-3962
Practice Address - Street 1:2102 E OSCEOLA PKWY
Practice Address - Street 2:SUITES 2102-2104
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-8630
Practice Address - Country:US
Practice Address - Phone:407-931-3962
Practice Address - Fax:407-932-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty