Supradent INC

NPI #1932276565 in Mount Dora, Florida

Provider Information

NPI Number: 1932276565
Entity Type: Organization
Organization Name: Supradent INC
Primary Specialty: Dentist - General Practice
Enumeration Date: Nov 29, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 18515 US HWY 441
City: Mount Dora
State: Florida
ZIP Code: 32757-6703
Phone: (352) 383-5377

Authorized Official

Name: DR. JAMES P COSTELLO, DDS
Title: PRESIDENT
Phone: (352) 408-1400

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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