Healthcare Provider Details

I. General information

NPI: 1376238469
Provider Name (Legal Business Name): DENTAL IMPLANT SPECIALISTS OF FLORIDA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 HARDEN BLVD
LAKELAND FL
33803-5917
US

IV. Provider business mailing address

3500 MAPLE AVE STE 1600
DALLAS TX
75219-3936
US

V. Phone/Fax

Practice location:
  • Phone: 863-665-8878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DAVID KIRKPATRICK
Title or Position: OWNER DENTIST
Credential:
Phone: 904-536-6550