MEDICARE: DAB DENTAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN19318	FL

General Provider Information

NPI Number	:	1154773653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAB DENTAL PLLC

Provider Business Mailing Address
First Line	:	3713 W WATROUS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5132
Country	:	US
Telephone Number	:	786-252-5995
Fax Number	:

Provider Business Practice Location Address
First Line	:	14953 N FLORIDA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-1612
Country	:	US
Telephone Number	:	813-269-9360
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DAIRA M AVILA BARAKAT
Credential	:	D.M.D
Telephone Number	:	786-252-5995

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	07/07/2016

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