Provider Demographics
NPI:1881707784
Name:PLANK, DAVID M (DDS MSD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:PLANK
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N LAKEMONT AVE
Mailing Address - Street 2:#2300
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3208
Mailing Address - Country:US
Mailing Address - Phone:407-629-1116
Mailing Address - Fax:407-629-4912
Practice Address - Street 1:201 N LAKEMONT AVE
Practice Address - Street 2:#2300
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3208
Practice Address - Country:US
Practice Address - Phone:407-629-1116
Practice Address - Fax:407-629-4912
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0005858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL60416Medicare ID - Type Unspecified