Provider Demographics
NPI:1912480963
Name:PEDIATRIC DENTISTRY OF WINTER PARK
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY OF WINTER PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-755-3136
Mailing Address - Street 1:325 PARK NORTH CT
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2552
Mailing Address - Country:US
Mailing Address - Phone:407-252-9539
Mailing Address - Fax:
Practice Address - Street 1:2001 LEE RD STE A
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1871
Practice Address - Country:US
Practice Address - Phone:407-755-3136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty