Healthcare Provider Details

I. General information

NPI: 1518653773
Provider Name (Legal Business Name): DENTAL THEORY BRANDON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1168 BELL SHOALS RD
BRANDON FL
33511-9014
US

IV. Provider business mailing address

1168 BELL SHOALS RD
BRANDON FL
33511-9014
US

V. Phone/Fax

Practice location:
  • Phone: 813-822-3058
  • Fax: 813-822-3059
Mailing address:
  • Phone: 813-822-3058
  • Fax: 813-822-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRIS JOHN KARAPASHA
Title or Position: DENTIST OWNER
Credential: DDS
Phone: 813-822-3058