Pediatric Dental Group, LLC
Dentist, Pediatric Dentistry in Orlando, FL. Organization (NPI-2).
NPI number1235697707
StatusActive
Last updated in NPPESMar 4, 2019
Details
- NPI
- 1235697707
- Entity type
- Organization (NPI-2)
- Legal business name
- Pediatric Dental Group, LLC
- Organization subpart
- No
- Enumeration date
- Mar 4, 2019
- Last updated
- Mar 4, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0221X | Dentist, Pediatric Dentistry | – | – | Yes |
Practice location
12601 Narcoossee RdUnite 100a
Orlando, FL 32832
Phone 407-737-7767 · Fax 407-737-0769
Mailing address
9161 Narcoossee RdSte 101b
Orlando, FL 32827
Phone 407-737-7767 · Fax 407-737-0769
Authorized official
Olubisi Alna
Co-Owner
4077377767
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