Healthcare Provider Details

I. General information

NPI: 1497047765
Provider Name (Legal Business Name): TIOGA DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13005 SW 1ST RD STE 233
JONESVILLE FL
32669-3266
US

IV. Provider business mailing address

13005 SW 1ST RD STE 233
JONESVILLE FL
32669-3266
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-1946
  • Fax: 352-333-9112
Mailing address:
  • Phone: 352-333-1946
  • Fax: 352-333-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN15173
License Number StateFL

VIII. Authorized Official

Name: DR. CYNTHIA BRUSH
Title or Position: PRESIDENT
Credential: DMD
Phone: 352-333-1946