Provider Demographics
NPI:1184069064
Name:BARAK DENTAL GROUP
Entity type:Organization
Organization Name:BARAK DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SISTRUNK- CARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-299-3232
Mailing Address - Street 1:2608 PIONEER RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808
Mailing Address - Country:US
Mailing Address - Phone:407-299-3232
Mailing Address - Fax:
Practice Address - Street 1:2608 PIONEER RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-3221
Practice Address - Country:US
Practice Address - Phone:407-299-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9771122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty