Provider Demographics
NPI:1922835461
Name:MBCO DENTAL PLLC
Entity type:Organization
Organization Name:MBCO DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-269-1400
Mailing Address - Street 1:1740 US HIGHWAY 27
Mailing Address - Street 2:STORE #28
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714
Mailing Address - Country:US
Mailing Address - Phone:352-269-1400
Mailing Address - Fax:
Practice Address - Street 1:1740 US HIGHWAY 27
Practice Address - Street 2:STORE #28
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714
Practice Address - Country:US
Practice Address - Phone:352-269-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty