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Organization
SOUTHPARK DENTAL GROUP
Active
Organization
SOUTHPARK DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN F CERVENKA D.D.S. (OWNER)
(407) 248-0100
Entity
Organization
Contact information
Practice address
8801 COMMODITY CIR, ORLANDO, FL 32819-9053
(407) 248-0100
(407) 248-8364
Mailing address
8801 COMMODITY CIR, ORLANDO, FL 32819-9053
(407) 248-0100
(407) 248-8364
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14090
FL
1223G0001X
General Practice Dentistry
13762
FL
1223G0001X
General Practice Dentistry
14238
FL
1223G0001X
General Practice Dentistry
16360
FL
1223G0001X
General Practice Dentistry
9168
FL
1223P0300X
Periodontics
12525
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
836729
UNITED CONCORDIA
—
Enumeration date
09/22/2006
Last updated
09/11/2025
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