Provider Demographics
NPI:1023431996
Name:CENTRAL FL DENTAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:CENTRAL FL DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-945-9545
Mailing Address - Street 1:11905 N US HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2833
Mailing Address - Country:US
Mailing Address - Phone:352-748-9688
Mailing Address - Fax:352-748-9687
Practice Address - Street 1:11905 N US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:FL
Practice Address - Zip Code:34484-2833
Practice Address - Country:US
Practice Address - Phone:352-748-7645
Practice Address - Fax:352-748-9865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty