Organization
TREVISANI ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMMY EAGLE (ADMINISTRATOR)
(407) 886-2050
Entity
Organization
Contact information
Practice address
2574 S VOLUSIA AVE, ORANGE CITY, FL 32763-9123
(386) 774-2999
(386) 774-4922
Mailing address
2574 S VOLUSIA AVE, ORANGE CITY, FL 32763-9123
(386) 774-2999
(386) 774-4922
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
DN13576
FL
Other
Enumeration date
03/28/2012
Last updated
03/28/2012
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