Provider Demographics
NPI:1669949616
Name:SOH OF FLORIDA PA
Entity type:Organization
Organization Name:SOH OF FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-674-8770
Mailing Address - Street 1:1422 ELBRIDGE PAYNE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 N MILLS AVE STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-7113
Practice Address - Country:US
Practice Address - Phone:407-674-8770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOH OF FLORIDA PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty