Healthcare Provider Details

I. General information

NPI: 1356413041
Provider Name (Legal Business Name): DAN O'KERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 LAKELAND HIGHLANDS RD
LAKELAND FL
33803-4370
US

IV. Provider business mailing address

2502 N ROCKY POINT DR SUITE 1000 8TH FLOOR
TAMPA FL
33607-1421
US

V. Phone/Fax

Practice location:
  • Phone: 863-665-1545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN17267
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: