Healthcare Provider Details

I. General information

NPI: 1477664266
Provider Name (Legal Business Name): FLORIDA DENTAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2189 CLEVELAND ST SUITE 252
CLEARWATER FL
33765
US

IV. Provider business mailing address

2189 CLEVELAND ST SUITE 252
CLEARWATER FL
33765
US

V. Phone/Fax

Practice location:
  • Phone: 727-461-9149
  • Fax: 727-446-8382
Mailing address:
  • Phone: 727-461-9149
  • Fax: 727-446-8382

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 Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN13680
License Number StateFL

VIII. Authorized Official

Name: DR. KEITH ALAN HUTCHINSON
Title or Position: OWNER
Credential: D.M.D.
Phone: 727-461-9149