Provider Demographics
NPI:1902158710
Name:KASHLAK, MARIA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:A
Last Name:KASHLAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6068 S. APOPLA VINELAND RD.
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819
Mailing Address - Country:US
Mailing Address - Phone:407-345-5620
Mailing Address - Fax:407-345-8063
Practice Address - Street 1:6068 S. APOPLA VINELAND RD.
Practice Address - Street 2:SUITE 6
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819
Practice Address - Country:US
Practice Address - Phone:407-345-5620
Practice Address - Fax:407-345-8063
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-00114691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice