Provider Demographics
NPI:1851710115
Name:THORNTON PARK DENTAL ARTS, PA
Entity Type:Organization
Organization Name:THORNTON PARK DENTAL ARTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-896-2881
Mailing Address - Street 1:1200 E ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2116
Mailing Address - Country:US
Mailing Address - Phone:407-896-2881
Mailing Address - Fax:407-897-5389
Practice Address - Street 1:1200 E ROBINSON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2116
Practice Address - Country:US
Practice Address - Phone:407-896-2881
Practice Address - Fax:407-897-5389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15092332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies