Provider Demographics
NPI:1851938070
Name:OAKPORT DENTAL SANFORD PLLC.
Entity Type:Organization
Organization Name:OAKPORT DENTAL SANFORD PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:P
Authorized Official - Last Name:AEBLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-323-5340
Mailing Address - Street 1:2421 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-4269
Mailing Address - Country:US
Mailing Address - Phone:407-323-5340
Mailing Address - Fax:
Practice Address - Street 1:2421 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-4269
Practice Address - Country:US
Practice Address - Phone:407-323-5340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies