Provider Demographics
NPI:1548654502
Name:OAKRIDGE PLAZA DENTAL,INC
Entity type:Organization
Organization Name:OAKRIDGE PLAZA DENTAL,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PURNIMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:407-363-1777
Mailing Address - Street 1:4029 W OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-3602
Mailing Address - Country:US
Mailing Address - Phone:407-363-1777
Mailing Address - Fax:407-248-1046
Practice Address - Street 1:4029 W OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-3602
Practice Address - Country:US
Practice Address - Phone:407-363-1777
Practice Address - Fax:407-248-1046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12966261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental