Healthcare Provider Details

I. General information

NPI: 1639774466
Provider Name (Legal Business Name): JAMES ESTES RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2119 W BRANDON BLVD STE F
BRANDON FL
33511-4731
US

IV. Provider business mailing address

5950 FISHHAWK CROSSING BLVD
LITHIA FL
33547-5878
US

V. Phone/Fax

Practice location:
  • Phone: 813-662-9340
  • Fax:
Mailing address:
  • Phone: 813-446-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: