Organization
CITY HALL DENTAL PL
Active
Parent organization
CHAMPION ORTHODONTICS PA
Other names
Dr Phillips Dental Specialists
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHAMPION ORTHODONTICS PA
Authorized official
DR. ALLA ALEXIS SHRAGER DMD (ORTHODONTIST)
(407) 351-5691
Entity
Organization
Contact information
Practice address
3311 DANIELS RD, STE 104, WINTER GARDEN, FL 34787-7000
(407) 656-0990
Mailing address
7932 W SAND LAKE RD, STE 105, ORLANDO, FL 32819-7263
(407) 351-5691
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN16446
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN16446
DENTAL LICENSE STATE OF FLORIDA
—
Enumeration date
01/04/2011
Last updated
01/04/2011
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