Southern Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN12260 Issued in FL

Legal business name

SOUTHERN DENTAL LLC

Practice address

2560 Maguire Rd
Ocoee, FL 34761-4749

Phone

(407) 656-5700

NPI assigned

Mar 23, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cary Freeman

Title

Insurance Counsler

Phone

(407) 656-5700

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710004171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2560 MAGUIRE RD",
            "city": "OCOEE",
            "state": "FL",
            "postal_code": "347614749",
            "telephone_number": "407-656-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2560 MAGUIRE RD",
            "city": "OCOEE",
            "state": "FL",
            "postal_code": "347614749",
            "telephone_number": "407-656-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "CARY",
        "authorized_official_title_or_position": "INSURANCE COUNSLER",
        "authorized_official_telephone_number": "407-656-5700"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN12260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Ocoee, FL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.