Provider Demographics
NPI:1124849781
Name:PARK DENTAL LLC
Entity type:Organization
Organization Name:PARK DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HAIDER
Authorized Official - Middle Name:ESSMAT
Authorized Official - Last Name:ALRAMLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-671-8901
Mailing Address - Street 1:2584 W STATE ROAD 426 UNIT 1020
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7693
Mailing Address - Country:US
Mailing Address - Phone:407-671-8901
Mailing Address - Fax:
Practice Address - Street 1:2584 W STATE ROAD 426 UNIT 1020
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7693
Practice Address - Country:US
Practice Address - Phone:407-671-8901
Practice Address - Fax:407-677-6368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty