LAKE BUTLER DENTAL GROUP PA – NPI #1124732698
Clinic/Center

LAKE BUTLER DENTAL GROUP PA is an AHC clinic located in WINTER GARDEN, FL. NPPES has assigned the NPI number 1124732698 to LAKE BUTLER DENTAL GROUP PA on January 10, 2023. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QD0000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Dental

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for LAKE BUTLER DENTAL GROUP PA below.

NPI Profile for
LAKE BUTLER DENTAL GROUP PA

NPI Number
1124732698
Enumeration Date

(more than 3 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
LAKE BUTLER DENTAL GROUP PA
Primary location
4014 WINTER GARDEN VINELAND ROAD
SUITE B
WINTER GARDEN, FL 34787
Phone: (321) 248-2923 Fax: (321) 418-8920
Mailing address
PO BOX 920050
DALLAS, TX 75392-0050
Phone: Fax:
Organization Subpart
No
Authorized Official
MINH PHAM
OWNER
Phone: (321) 248-2923
Updated
Certification Date
Jan 06, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QD0000X
- Clinic/Center / Dental (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.