Provider Demographics
NPI:1871017566
Name:CMV FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:CMV FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VARELA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-613-2646
Mailing Address - Street 1:1601 N GOLDENROD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-8308
Mailing Address - Country:US
Mailing Address - Phone:407-613-2646
Mailing Address - Fax:407-986-7976
Practice Address - Street 1:1601 N GOLDENROD RD STE 1
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-8308
Practice Address - Country:US
Practice Address - Phone:321-663-0568
Practice Address - Fax:407-986-7976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22914122300000X
FLDN22828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty