Organization
HOUSE OF COSMETIC DENTISTRY
Active
Other names
Fortune Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LINA SEGURA (OFFICE MANAGER)
(407) 348-2002
Entity
Organization
Contact information
Practice address
2324 FORTUNE RD, KISSIMMEE, FL 34744-3993
(407) 348-2002
(407) 348-2009
Mailing address
2324 FORTUNE RD, KISSIMMEE, FL 34744-3993
(407) 348-2002
(407) 348-2009
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN16387
FL
1223G0001X
General Practice Dentistry
DN16586
FL
Other
Enumeration date
08/03/2011
Last updated
09/02/2015
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