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NPI Code Detail

MEDICARE: MARINA DENTAL & DENTURE CLINIC PA

MEDICARE: MARINA DENTAL & DENTURE CLINIC PA
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
1122300000XDentist

General Provider Information

NPI Number : 1275692154
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARINA DENTAL & DENTURE CLINIC PA
Provider Business Mailing Address
First Line : 25 CAUSEWAY BLVD
Second Line : SUITE 20
City : CLEARWATER BEACH
State : FL
Zip : 33767-2099
Country : US
Telephone Number : 727-441-8225
Fax Number : 727-441-8225
Provider Business Practice Location Address
First Line : 25 CAUSEWAY BLVD
Second Line : SUITE 20
City : CLEARWATER BEACH
State : FL
Zip : 33767-2099
Country : US
Telephone Number : 727-441-8225
Fax Number : 727-441-8225
Authorized Official
Title or Position : PRESIDENT OF CORPORATION
Name : DAVID S PETRIK
Credential : DDS
Telephone Number : 727-441-8225
Provider Enumeration Date : 12/07/2006
Last Update Date : 08/22/2020

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Directions to “MARINA DENTAL & DENTURE CLINIC PA ” Practice Location

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