Provider Demographics
NPI:1881068559
Name:INNOVATIVE DENTAL & ORTHODONTICS, P.A.
Entity type:Organization
Organization Name:INNOVATIVE DENTAL & ORTHODONTICS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMAT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-528-6955
Mailing Address - Street 1:1884 W. COUNTY RD 419
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765
Mailing Address - Country:US
Mailing Address - Phone:407-797-6940
Mailing Address - Fax:
Practice Address - Street 1:1884 W. COUNTY RD 419
Practice Address - Street 2:SUITE 1010
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765
Practice Address - Country:US
Practice Address - Phone:407-797-6940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN187061223X0400X
FLDN185571223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty