Provider Demographics
NPI:1134545593
Name:INSPIRATION DENTAL
Entity type:Organization
Organization Name:INSPIRATION DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHELEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-543-8103
Mailing Address - Street 1:801 WILLOW CREEK LN
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1745
Mailing Address - Country:US
Mailing Address - Phone:813-677-1200
Mailing Address - Fax:813-677-1228
Practice Address - Street 1:13122 VAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7187
Practice Address - Country:US
Practice Address - Phone:813-677-1200
Practice Address - Fax:813-677-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty