Healthcare Provider Details

I. General information

NPI: 1972905222
Provider Name (Legal Business Name): DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 NW 57TH ST
GAINESVILLE FL
32605-6458
US

IV. Provider business mailing address

9400 4TH ST N STE 200
ST PETERSBURG FL
33702-2501
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-8199
  • Fax: 941-332-7775
Mailing address:
  • Phone: 727-800-8026
  • Fax: 727-339-6543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ROSA LESSO
Title or Position: NATIONAL DIRECTOR OF RCM
Credential:
Phone: 714-571-3471