Provider Demographics
NPI:1265766273
Name:LG DENTAL GROUP
Entity type:Organization
Organization Name:LG DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-240-4900
Mailing Address - Street 1:12927 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6592
Mailing Address - Country:US
Mailing Address - Phone:407-240-4900
Mailing Address - Fax:
Practice Address - Street 1:12927 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6592
Practice Address - Country:US
Practice Address - Phone:407-240-4900
Practice Address - Fax:407-240-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty