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Organization

CARLA TALAVERA-JORDAN D.M.D., P.A.

Active
Other names
South Lake Dental
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CARLA PATRICIA TALAVERA-JORDAN D.M.D. (PRESIDENT)
(352) 242-0912
Entity
Organization

Contact information

Practice address
533 CAGAN PARK AVE, SUITE 307, CLERMONT, FL 34714
(352) 242-0912
(352) 242-2712
Mailing address
533 CAGAN PARK AVE, SUITE 307, CLERMONT, FL 34714-4867
(352) 242-0912

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN 16454
FL

Other

Enumeration date
05/10/2007
Last updated
11/26/2011
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