# ORLANDO ORAL & FACIAL SURGERY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205920204
- **Authorized official:** MRS. EVELIS GERENA (ACCOUNTS PAYABLE)
- **Authorized official phone:** (407) 629-4444

## Contact information

- **Practice address:** 2045 LEE RD, WINTER PARK, FL 32789-1836
- **Practice address phone:** (407) 629-4444
- **Practice address fax:** (407) 629-9078
- **Mailing address:** 2045 LEE RD, WINTER PARK, FL 32789-1836
- **Mailing address phone:** (407) 629-4444
- **Mailing address fax:** (407) 629-9078

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | NULL | — |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |
| 1223X0008X | Oral and Maxillofacial Radiology Dentistry | — | NULL | — |
| 1223X0008X | Oral and Maxillofacial Radiology Dentistry | — | — | — |
| 174400000X | Specialist | — | NULL | — |
| 174400000X | Specialist | — | — | — |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 06/02/2016