Provider Demographics
NPI:1457593014
Name:ECON DENTAL PLLC
Entity Type:Organization
Organization Name:ECON DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:CARMELO
Authorized Official - Last Name:GAUD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-972-8312
Mailing Address - Street 1:2529 BLACK LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4756
Mailing Address - Country:US
Mailing Address - Phone:321-972-8312
Mailing Address - Fax:
Practice Address - Street 1:3823 N ECONLOCKHATCHEE TRL UNIT D-4
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1640
Practice Address - Country:US
Practice Address - Phone:321-972-8312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-29
Last Update Date:2009-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17231261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1013926377OtherNPI DR. OMAYRA TORRES
PR1386845725OtherNPI DR. LUIS C. GAUD