Provider Demographics
NPI:1689413403
Name:AESTHETIC DENTISTRY OF ORLANDO
Entity type:Organization
Organization Name:AESTHETIC DENTISTRY OF ORLANDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAOKO
Authorized Official - Middle Name:
Authorized Official - Last Name:FUKUSHIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-720-5812
Mailing Address - Street 1:316 N ALAFAYA TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7000
Mailing Address - Country:US
Mailing Address - Phone:407-720-5812
Mailing Address - Fax:407-720-5812
Practice Address - Street 1:316 N ALAFAYA TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7000
Practice Address - Country:US
Practice Address - Phone:407-720-5812
Practice Address - Fax:407-720-5812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental