Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 20342 | FL |
NPI | 1083051924 |
---|---|
Provider Name | Dr. Ludmils Antonos JR. |
First Address | Winter Garden, FL 34787-4674 |
Second Address | Orlando, FL 32819-8000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2013 |
Last Update Date | 19/06/2017 |