MEDICARE: SRQ 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1922803659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SRQ DENTAL, PLLC

Provider Business Mailing Address
First Line	:	832 FREELING DR
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34242-1025
Country	:	US
Telephone Number	:	512-663-7611
Fax Number	:

Provider Business Practice Location Address
First Line	:	5670 FRUITVILLE RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34232-6407
Country	:	US
Telephone Number	:	941-231-0225
Fax Number	:

Authorized Official
Title or Position	:	PARTNER/OWNER
Name	:	DR. DANIELLE DAVIS
Credential	:	DMD
Telephone Number	:	512-663-7611

Provider Enumeration Date	:	02/17/2025
Last Update Date	:	02/17/2025

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Directions to “SRQ DENTAL, PLLC ” Practice Location

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