Provider Demographics
NPI:1649510975
Name:FAMILY DENTISTRY & DENTAL SPECIALISTS GROUP
Entity type:Organization
Organization Name:FAMILY DENTISTRY & DENTAL SPECIALISTS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANMOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS,MDS,MS
Authorized Official - Phone:407-421-6888
Mailing Address - Street 1:9336 SOUTHERN BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5056
Mailing Address - Country:US
Mailing Address - Phone:407-421-6888
Mailing Address - Fax:
Practice Address - Street 1:4250 TOWN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6192
Practice Address - Country:US
Practice Address - Phone:407-856-0208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP96000000303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty