Provider Demographics
NPI:1770266926
Name:PEDIATRIC DENTISTRY OF CENTRAL FLORIDA, LLP
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY OF CENTRAL FLORIDA, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTOT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-628-2286
Mailing Address - Street 1:1650 N MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-3320
Mailing Address - Country:US
Mailing Address - Phone:407-628-2286
Mailing Address - Fax:
Practice Address - Street 1:1650 N MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-3320
Practice Address - Country:US
Practice Address - Phone:407-628-2286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty