Provider Demographics
NPI:1396427621
Name:PRESTIGE SURGICAL ARTS & IMPLANTS CENTER
Entity type:Organization
Organization Name:PRESTIGE SURGICAL ARTS & IMPLANTS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-794-0335
Mailing Address - Street 1:7703 SADLER RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-7230
Mailing Address - Country:US
Mailing Address - Phone:407-754-7652
Mailing Address - Fax:
Practice Address - Street 1:320 N MAITLAND AVE STE A
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4772
Practice Address - Country:US
Practice Address - Phone:407-794-0335
Practice Address - Fax:407-794-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty