Healthcare Provider Details

I. General information

NPI: 1760002901
Provider Name (Legal Business Name): NAN ZHONG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 LAKEVIEW RD STE 1
CLEARWATER FL
33756-3302
US

IV. Provider business mailing address

516 LAKEVIEW RD STE 1
CLEARWATER FL
33756-3302
US

V. Phone/Fax

Practice location:
  • Phone: 727-620-5858
  • Fax: 727-620-5858
Mailing address:
  • Phone: 727-620-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN25134
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: