Provider Demographics
NPI:1205920204
Name:ORLANDO ORAL & FACIAL SURGERY PLLC
Entity type:Organization
Organization Name:ORLANDO ORAL & FACIAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS PAYABLE
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GERENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-629-4444
Mailing Address - Street 1:2045 LEE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1836
Mailing Address - Country:US
Mailing Address - Phone:407-629-4444
Mailing Address - Fax:407-629-9078
Practice Address - Street 1:2045 LEE RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1836
Practice Address - Country:US
Practice Address - Phone:407-629-4444
Practice Address - Fax:407-629-9078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24650Medicare PIN