Individual
JIM VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2050 OLD HICKORY TREE RD, SAINT CLOUD, FL 34772-8926
(407) 556-3696
Mailing address
2704 CYPRESSWAY CT, ORLANDO, FL 32825-8563
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN23005
FL
Other
Enumeration date
08/16/2017
Last updated
08/17/2017
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