Provider Demographics
NPI:1184886442
Name:CLASSIC DENTAL AT OVIEDO
Entity type:Organization
Organization Name:CLASSIC DENTAL AT OVIEDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CEASAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-302-7774
Mailing Address - Street 1:2989 ALAFAYA TRAIL
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765
Mailing Address - Country:US
Mailing Address - Phone:407-695-7774
Mailing Address - Fax:407-366-4339
Practice Address - Street 1:2989 ALAFAYA TRAIL
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765
Practice Address - Country:US
Practice Address - Phone:407-695-7774
Practice Address - Fax:407-366-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty