MEDICARE: SERENITY DENTAL

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	DN16415	FL
2	1223G0001X	General Practice Dentistry	DN16043	FL

General Provider Information

NPI Number	:	1952700247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY DENTAL

Provider Business Mailing Address
First Line	:	1849 COLLIER PKWY
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-8718
Country	:	US
Telephone Number	:	813-909-8400
Fax Number	:	813-909-7060

Provider Business Practice Location Address
First Line	:	1849 COLLIER PKWY
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-8718
Country	:	US
Telephone Number	:	813-909-8400
Fax Number	:	813-909-7060

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	NILA PATEL
Credential	:
Telephone Number	:	813-909-8400

Provider Enumeration Date	:	08/22/2014
Last Update Date	:	08/22/2014

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Directions to “SERENITY DENTAL ” Practice Location

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