Provider Demographics
NPI:1972609055
Name:OROFACIAL & DENTAL IMPLANT SURGERY ASSOCIATES PA
Entity Type:Organization
Organization Name:OROFACIAL & DENTAL IMPLANT SURGERY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OFILIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-351-0575
Mailing Address - Street 1:7352 STONEROCK CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8000
Mailing Address - Country:US
Mailing Address - Phone:407-351-0575
Mailing Address - Fax:407-363-6945
Practice Address - Street 1:7352 STONEROCK CIR
Practice Address - Street 2:SUITE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8000
Practice Address - Country:US
Practice Address - Phone:407-351-0575
Practice Address - Fax:407-363-6945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN129341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1609987635OtherNPI
FLU38934Medicare UPIN
0069233XMedicare ID - Type Unspecified