Provider Demographics
NPI:1871755124
Name:CLASSIC DENTAL AT MAITLAND LLC
Entity type:Organization
Organization Name:CLASSIC DENTAL AT MAITLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CEASAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-302-7774
Mailing Address - Street 1:158 LOOKOUT PL
Mailing Address - Street 2:SUITE #101
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4411
Mailing Address - Country:US
Mailing Address - Phone:407-682-7774
Mailing Address - Fax:407-628-5651
Practice Address - Street 1:158 LOOKOUT PL
Practice Address - Street 2:SUITE #101
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4411
Practice Address - Country:US
Practice Address - Phone:407-682-7774
Practice Address - Fax:407-628-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty