Provider Demographics
NPI:1396087581
Name:WEST ORANGE DENTAL GROUP, LLC
Entity type:Organization
Organization Name:WEST ORANGE DENTAL GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AKINYINKA
Authorized Official - Middle Name:
Authorized Official - Last Name:AWOSIKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-290-9588
Mailing Address - Street 1:217 N KIRKMAN RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-1186
Mailing Address - Country:US
Mailing Address - Phone:407-290-9588
Mailing Address - Fax:407-292-6190
Practice Address - Street 1:217 N KIRKMAN RD
Practice Address - Street 2:SUITE 3
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-1186
Practice Address - Country:US
Practice Address - Phone:407-290-9588
Practice Address - Fax:407-292-6190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN168561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty