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Organization
SUMMIT PARK DENTAL, INC
Active
Organization
SUMMIT PARK DENTAL, INC
Active
Other names
Lake Quality Dental
Organization subpart
No
Provider details
NPI number
Authorized official
PHUONG TA (PRESIDENT / OWNER)
(352) 255-5538
Entity
Organization
Contact information
Practice address
723 CR 466, LADY LAKE, FL 32159
(352) 430-0543
(352) 430-0702
Mailing address
440 CHINAHILL CT, APOPKA, FL 32712
(352) 430-0543
(352) 430-0702
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
ND14668
FL
Other
Enumeration date
09/26/2012
Last updated
09/26/2012
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