Healthcare Provider Details

I. General information

NPI: 1225914864
Provider Name (Legal Business Name): EAST BAY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E BAY DR STE 1
LARGO FL
33771-5616
US

IV. Provider business mailing address

1601 E BAY DR STE 1
LARGO FL
33771-5616
US

V. Phone/Fax

Practice location:
  • Phone: 727-585-5675
  • Fax: 727-588-0114
Mailing address:
  • Phone: 727-585-5675
  • Fax: 727-588-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AMY GIANG DOAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 727-585-5675