1790933554 NPI number — SIGMA DENTAL OF KISSIMMEE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790933554 NPI number — SIGMA DENTAL OF KISSIMMEE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIGMA DENTAL OF KISSIMMEE, LLC
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:
6
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:
1790933554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2102 E OSCEOLA PKWY
Provider Second Line Business Mailing Address:
SUITES 2102-2104
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34743-8630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-201-3998
Provider Business Mailing Address Fax Number:
407-931-3962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2102 E OSCEOLA PKWY
Provider Second Line Business Practice Location Address:
SUITES 2102-2104
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34743-8630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-931-3962
Provider Business Practice Location Address Fax Number:
407-932-0800
Provider Enumeration Date:
09/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SOPRANO
Authorized Official First Name:
FABIOLA
Authorized Official Middle Name:
ELENA
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
407-451-5866

Provider Taxonomy Codes

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

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





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