Healthcare Provider Details

I. General information

NPI: 1003413642
Provider Name (Legal Business Name): DENTAL CONTRACTED SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 DREWRYS BLF
BRADENTON FL
34203-7861
US

IV. Provider business mailing address

6501 DREWRYS BLF
BRADENTON FL
34203-7861
US

V. Phone/Fax

Practice location:
  • Phone: 941-228-7788
  • Fax:
Mailing address:
  • Phone: 941-228-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID SUNDEEN
Title or Position: PRESIDENT
Credential: DDS
Phone: 941-228-7788