Healthcare Provider Details

I. General information

NPI: 1760085930
Provider Name (Legal Business Name): DENTAL ARTS NEW PORT RICHEY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4754 ROWAN RD
NEW PORT RICHEY FL
34653-5601
US

IV. Provider business mailing address

4754 ROWAN RD
NEW PORT RICHEY FL
34653-5601
US

V. Phone/Fax

Practice location:
  • Phone: 727-376-2559
  • Fax:
Mailing address:
  • Phone: 727-376-2559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: ANDREW CROUCH
Title or Position: VP
Credential:
Phone: 321-872-8820