Organization
LAKE EOLA DENTAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOANG HO DMD (OWNER)
(804) 687-2817
Entity
Organization
Contact information
Practice address
338 N MAGNOLIA AVE STE C, ORLANDO, FL 32801-1639
(407) 930-7007
(407) 930-5410
Mailing address
338 N MAGNOLIA AVE STE C, ORLANDO, FL 32801-1639
(407) 930-7007
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396124509
—
VA
Enumeration date
06/21/2017
Last updated
08/17/2022
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