Provider Demographics
NPI:1255754065
Name:CENTRAL FLORIDA DENTAL CARE, LLC
Entity type:Organization
Organization Name:CENTRAL FLORIDA DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-735-5255
Mailing Address - Street 1:2390 W OLD 441 STE 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-3534
Mailing Address - Country:US
Mailing Address - Phone:352-735-5255
Mailing Address - Fax:352-383-9865
Practice Address - Street 1:2390 W OLD US HIGHWAY 441
Practice Address - Street 2:STE #2
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-3534
Practice Address - Country:US
Practice Address - Phone:352-383-3368
Practice Address - Fax:352-383-9865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 13227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty