Provider Demographics
NPI:1205955853
Name:SOUTH ORLANDO DENTAL PA
Entity type:Organization
Organization Name:SOUTH ORLANDO DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:PYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-330-3801
Mailing Address - Street 1:7221 CHANCERY LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7039
Mailing Address - Country:US
Mailing Address - Phone:407-855-0474
Mailing Address - Fax:407-855-0197
Practice Address - Street 1:7221 CHANCERY LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7039
Practice Address - Country:US
Practice Address - Phone:407-855-0474
Practice Address - Fax:407-855-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN61061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty