Provider Demographics
NPI:1124989231
Name:LAKE BALDWIN DENTAL OF ORLANDO PLLC
Entity type:Organization
Organization Name:LAKE BALDWIN DENTAL OF ORLANDO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:NESTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-873-3788
Mailing Address - Street 1:950 LAKE BALDWIN LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6651
Mailing Address - Country:US
Mailing Address - Phone:407-515-8500
Mailing Address - Fax:
Practice Address - Street 1:950 LAKE BALDWIN LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6651
Practice Address - Country:US
Practice Address - Phone:407-515-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty