Organization
PEDIATRIC AND FAMILY DENTAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JOCELYN ESPEJO (PRACTICE MANAGER)
(407) 737-7767
Entity
Organization
Contact information
Practice address
6161 WINEGARD RD, ORLANDO, FL 32809-4977
(407) 749-0113
(407) 786-5878
Mailing address
PO BOX 590710, ORLANDO, FL 32859-0710
(407) 749-0113
(407) 786-5878
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN19618
FL
122300000X
Dentist
DN20790
FL
1223P0221X
Pediatric Dentistry
Primary
DN17111
FL
1223P0221X
Pediatric Dentistry
DN18209
FL
Other
Enumeration date
09/15/2014
Last updated
07/28/2015
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