Individual
GREGORIO WAYNE BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
909 E OAK ST STE A, KISSIMMEE, FL 34744
(407) 847-2103
(407) 847-5042
Mailing address
4719 LEGACY OAKS DR, ORLANDO, FL 32839-2067
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN13033
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017646700
—
FL
Enumeration date
12/31/2007
Last updated
03/07/2023
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