Provider Demographics
NPI:1679611123
Name:LAYTON, J. MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:J.
Middle Name:MICHAEL
Last Name:LAYTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 N NARCOOSSEE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-8759
Mailing Address - Country:US
Mailing Address - Phone:407-847-7671
Mailing Address - Fax:407-847-2635
Practice Address - Street 1:2901 E IRLO BRONSON MEMORIAL HWY
Practice Address - Street 2:SUITE B
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5600
Practice Address - Country:US
Practice Address - Phone:407-847-7671
Practice Address - Fax:407-847-2635
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00113021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice