# TREVISANI ORAL SURGERY THE VILLAGES

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

## Provider details

- **NPI number:** 1689160434
- **Authorized official:** TAMI VARGAS (OFFICE MANAGER)
- **Authorized official phone:** (407) 886-2050

## Contact information

- **Practice address:** 929 N HWY 441, SUITE 302, LADY LAKE, FL 32159
- **Practice address phone:** (352) 751-5100
- **Practice address fax:** (407) 886-2117
- **Mailing address:** 929 N US HIGHWAY 441, LADY LAKE, FL 32159-3001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DN13576 | FL | Yes |

## Other

- **Enumeration date:** 07/05/2018
- **Last updated:** 07/05/2018