Dentist of Lake Mary LLC

NPI #1124622659 in Lake Mary, Florida

Provider Information

NPI Number: 1124622659
Entity Type: Organization
Organization Name: Dentist of Lake Mary LLC
Primary Specialty: Dentist
Enumeration Date: Nov 25, 2020
Last Updated: Nov 25, 2020

Practice Location

Address: 229 WHEELHOUSE LN STE 1241
City: Lake Mary
State: Florida
ZIP Code: 32746-3665
Phone: (407) 284-1645

Authorized Official

Name: DHARAM PAL TAYAL, DDS
Title: MEMBER
Phone: (716) 239-5889

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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