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
1410 W BROADWAY ST, SUITE 204, OVIEDO, FL 32765-6456
(407) 366-2243
(407) 359-3343
Mailing address
1410 W BROADWAY ST, SUITE 204, OVIEDO, FL 32765-6456
(407) 366-2243
(407) 359-3343
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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