Organization Active NPI

Orlando Endodontic Specialists-East

  • Endodontics
  • Orlando, FL
National Provider Identifier
1396060430
Registry record updated Apr 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
DN14384 Issued in FL
Legal business name
ORLANDO ENDODONTIC SPECIALISTS-EAST
Practice address
12301 Lake Underhill Rd
Ste 107
Orlando, FL 32828-4508
Phone
(407) 581-9515
Fax
(407) 581-9520
NPI assigned
Apr 1, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susie Bobo
Title
Office Manager
Phone
(407) 581-9505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223E0200X DN14384 FL Primary

Addresses

Primary practice location

12301 Lake Underhill Rd
Ste 107
Orlando, FL 32828-4508

Mailing address

610 N Mills Ave
Ste 210
Orlando, FL 32803-7119
Phone (407) 423-7667

National Provider Directory

National Provider Directory

Locations

12301 Lake Underhill Rd
Ste 107
Orlando, FL 32828
Phone (407) 277-3300

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1270080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270080000000",
    "number": "1396060430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 N MILLS AVE",
            "address_2": "STE 210",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328037119",
            "telephone_number": "407-423-7667",
            "fax_number": "407-425-8629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12301 LAKE UNDERHILL RD",
            "address_2": "STE 107",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328284508",
            "telephone_number": "407-581-9515",
            "fax_number": "407-581-9520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORLANDO ENDODONTIC SPECIALISTS-EAST",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-01",
        "last_updated": "2010-04-01",
        "status": "A",
        "authorized_official_last_name": "BOBO",
        "authorized_official_first_name": "SUSIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "407-581-9505"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "FL",
            "license": "DN14384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.