Supradent INC
Dentist, General Practice in Mount Dora, FL. Organization (NPI-2).
NPI number1932276565
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1932276565
- Entity type
- Organization (NPI-2)
- Legal business name
- Supradent INC
- Organization subpart
- No
- Enumeration date
- Nov 29, 2006
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Other names
- Tri Dental (Doing Business As)
Practice location
18515 Us Hwy 441Mount Dora, FL 32757-6703
Phone 352-383-5377 · Fax 352-383-2513
Mailing address
18515 Us Hwy 441Mount Dora, FL 32757-6703
Phone 352-383-5377 · Fax 352-383-2513
Authorized official
James P Costello
President
3524081400
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