# WINTER HAVEN ORAL SURGERY, PA

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

## Provider details

- **NPI number:** 1609122357
- **Authorized official:** DR. JOSE LUIS LEON RAMIREZ DMD, MD (VICE PRESIDENT)
- **Authorized official phone:** (863) 294-7648

## Contact information

- **Practice address:** 400 AVENUE K SE, SUITE \# 14A, WINTER HAVEN, FL 33880-4146
- **Practice address phone:** (863) 294-7648
- **Practice address fax:** (863) 294-9045
- **Mailing address:** 400 AVENUE K SE, SUITE \# 14A, WINTER HAVEN, FL 33880-4146
- **Mailing address phone:** (863) 294-7648
- **Mailing address fax:** (863) 294-9045

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DN18539 | FL | Yes |

## Other

- **Enumeration date:** 07/31/2012
- **Last updated:** 08/21/2014