Healthcare Provider Details

I. General information

NPI: 1962321851
Provider Name (Legal Business Name): SANTINO ESPOSITO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 LAND O LAKES BLVD STE 101
LUTZ FL
33549-2903
US

IV. Provider business mailing address

12889 139TH ST
LARGO FL
33774-2404
US

V. Phone/Fax

Practice location:
  • Phone: 813-948-0404
  • Fax:
Mailing address:
  • Phone: 727-253-9436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN32107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: