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Advanced Dental INC.

Dentist in Port Orange, FL. Organization (NPI-2).

NPI number1669503264
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1669503264
Entity type
Organization (NPI-2)
Legal business name
Advanced Dental INC.
Organization subpart
No
Enumeration date
Mar 8, 2007
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X DentistDN12614FLYes

Other names

  • Advanced Dental Care (Doing Business As)

Practice location

1525 Herbert St
Suite 101
Port Orange, FL 32129-6106

Phone 386-322-7786 · Fax 386-761-3920

Mailing address

1525 Herbert St
Suite 101
Port Orange, FL 32129-6106

Phone 386-322-7786 · Fax 386-761-3920

Authorized official

Luis O. Soto
President
3863227786

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