1063594802 NPI number — OVIEDA DENTAL CENTER

Table of content: WILLIAM ANTHONY GRINTER RN (NPI 1972217222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063594802 NPI number — OVIEDA DENTAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OVIEDA DENTAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063594802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2959 ALAFAYA TRAIL STE 109
Provider Second Line Business Mailing Address:
OVIEDO DENTAL CENTER
Provider Business Mailing Address City Name:
OVIEDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-366-2363
Provider Business Mailing Address Fax Number:
407-366-9564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2959 ALAFAYA TRAIL STE 109
Provider Second Line Business Practice Location Address:
OVIEDO DENTAL CENTER
Provider Business Practice Location Address City Name:
OVIEDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-366-2363
Provider Business Practice Location Address Fax Number:
407-366-9564
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SEOANE
Authorized Official First Name:
MARITZA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-366-2363

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 014468500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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