Provider Demographics
NPI:1982225132
Name:LAKE FOREST ENDODONTICS, PA
Entity Type:Organization
Organization Name:LAKE FOREST ENDODONTICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-423-7667
Mailing Address - Street 1:610 N MILLS AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803
Mailing Address - Country:US
Mailing Address - Phone:407-423-7667
Mailing Address - Fax:407-425-8629
Practice Address - Street 1:5264 W STATE ROAD 46
Practice Address - Street 2:UNIT C4
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771
Practice Address - Country:US
Practice Address - Phone:407-577-3636
Practice Address - Fax:407-317-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty