Healthcare Provider Details

I. General information

NPI: 1962325464
Provider Name (Legal Business Name): SALT & LIGHT DENTAL CO. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16226 REDSTONE WAY
ODESSA FL
33556-4668
US

IV. Provider business mailing address

7901 4TH ST N STE 300
ST. PETERSBURG FL
33702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 813-838-9299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANNA KATRINA CANTA OLAES
Title or Position: OWNER
Credential:
Phone: 813-543-5878