1154838365 NPI number — TREVISANI ORAL SURGERY ORLANDO PLC

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 1154838365 NPI number — TREVISANI ORAL SURGERY ORLANDO PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TREVISANI ORAL SURGERY ORLANDO PLC
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:
1154838365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 WEKIVA COMMONS CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APOPKA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32712-3645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-886-2050
Provider Business Mailing Address Fax Number:
407-886-2117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10967 LAKE UNDERHILL RD STE 144
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32825-4456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-764-9900
Provider Business Practice Location Address Fax Number:
407-764-9902
Provider Enumeration Date:
01/09/2018

Additional Information

Authorized Official

Authorized Official Last Name:
VARGAS
Authorized Official First Name:
TAMI
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
407-886-2050

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  DN13576 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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