Provider Demographics
NPI:1992133995
Name:FLORIDA ORTHODONTIC INSTITUTE
Entity type:Organization
Organization Name:FLORIDA ORTHODONTIC INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-264-7006
Mailing Address - Street 1:5020 GUNN HWY
Mailing Address - Street 2:#200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-6379
Mailing Address - Country:US
Mailing Address - Phone:813-264-7006
Mailing Address - Fax:813-264-6072
Practice Address - Street 1:5020 GUNN HWY
Practice Address - Street 2:#200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-6379
Practice Address - Country:US
Practice Address - Phone:813-264-7006
Practice Address - Fax:813-264-6072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11575261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental