Provider Demographics
NPI:1053365338
Name:CENTRAL FLORIDA ORAL & MAXILLOFACIAL SURGERY
Entity type:Organization
Organization Name:CENTRAL FLORIDA ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILBUR
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-843-2261
Mailing Address - Street 1:610 N MILLS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-7103
Mailing Address - Country:US
Mailing Address - Phone:407-843-2261
Mailing Address - Fax:407-841-0247
Practice Address - Street 1:610 N MILLS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-7119
Practice Address - Country:US
Practice Address - Phone:407-843-2261
Practice Address - Fax:407-841-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24194BMedicare PIN
FL24194AMedicare PIN