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Organization
SPRING LAKE GROUP, PA
Active
Organization
SPRING LAKE GROUP, PA
Active
Other names
Dental Care of Dr. Phillips
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNE THAO NGUYEN DDS (OWNER)
(408) 455-2471
Entity
Organization
Contact information
Practice address
7051 DR PHILLIPS BLVD STE 10, ORLANDO, FL 32819-5140
(407) 345-1442
Mailing address
125 RIDGEWOOD DR, LONGWOOD, FL 32779-3312
(408) 455-2471
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
572237939
PASSPORT
—
01
—
N250058777110
FLORIDA DRIVERS LICENSE
FL
Enumeration date
02/23/2018
Last updated
02/23/2018
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