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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