MEDICARE: DR. PHUONG HELENE TA DDS

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	1223G0001X	General Practice Dentistry	DN14668	FL

General Provider Information

NPI Number	:	1811050917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHUONG HELENE TA DDS

Provider Business Mailing Address
First Line	:	1503 BUENOS AIRES BLVD STE 125
Second Line	:
City	:	LADY LAKE
State	:	FL
Zip	:	32159-6826
Country	:	US
Telephone Number	:	352-753-5838
Fax Number	:	352-391-5837

Provider Business Practice Location Address
First Line	:	36800 WINFIELD CT
Second Line	:
City	:	GRAND ISLAND
State	:	FL
Zip	:	32735-9131
Country	:	US
Telephone Number	:	352-255-5538
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	05/07/2015

Similar Medicare Providers

1447762380 — SHANE BRIDGMAN DNP, APRN, AGNP-BC
Practice Location Address:

36624 GRAND ISLAND OAKS CIR
GRAND ISLAND, FL
32735-9653

Practice Phone: 352-801-9272
Practice Fax: 908-274-2081

1760439525 — PHILLIP M DASCHER MD
Practice Location Address:

36211 DASCHER LN
GRAND ISLAND, FL
32735-9614

Practice Phone: 352-636-4768
Practice Fax:

1518013713 — DENISE SPROUSE HARRISON M.ED.,CCC/SLP
Practice Location Address:

36006 VIA GRAN
GRAND ISLAND, FL
32735-9625

Practice Phone: 352-483-1181
Practice Fax: 352-483-1181

1003949231 — MICHELLE ANN HARRISON COTA
Practice Location Address:

13511 BISCAYNE DR
GRAND ISLAND, FL
32735-8926

Practice Phone: 863-248-4155
Practice Fax: 863-248-4157

1871702878 — PATRICIA M BRANT OT
Practice Location Address:

13622 GRAND ISLAND SHORES RD
GRAND ISLAND, FL
32735-9626

Practice Phone: 352-357-6376
Practice Fax:

1265785687 — MRS. ANGELA MASOLINE THOMAS
Practice Location Address:

13633 SAND BLUFF LN
GRAND ISLAND, FL
32735-8951

Practice Phone: 352-255-6458
Practice Fax:

Directions to “ DR. PHUONG HELENE TA DDS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.