1346806627 NPI number — PLANES DENTAL ARTS LAKE NONA

Table of content: (NPI 1346806627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346806627 NPI number — PLANES DENTAL ARTS LAKE NONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLANES DENTAL ARTS LAKE NONA
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:
1346806627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10157 S FEDERAL HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT SAINT LUCIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34952-5609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-337-1127
Provider Business Mailing Address Fax Number:
772-337-1121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9436 NARCOOSSEE RD
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:
32827-5705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-337-1127
Provider Business Practice Location Address Fax Number:
772-337-1121
Provider Enumeration Date:
05/13/2019

Additional Information

Authorized Official

Authorized Official Last Name:
PLANES
Authorized Official First Name:
ALEX
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
772-231-6004

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: DN20254 . This is a "GENERAL DENTISTRY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com