Healthcare Provider Details

I. General information

NPI: 1932456571
Provider Name (Legal Business Name): CORNERSTONE DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 12/24/2019
Certification Date: 12/24/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 TAMPA RD SUITE 6
OLDSMAR FL
34677-3206
US

IV. Provider business mailing address

4009 TAMPA RD SUITE 6
OLDSMAR FL
34677-3206
US

V. Phone/Fax

Practice location:
  • Phone: 813-448-7828
  • Fax:
Mailing address:
  • Phone: 813-448-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN00186
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN18577
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN 14080
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberF11975
License Number StateFL

VIII. Authorized Official

Name: KEVIN AUBREY FRANKLIN
Title or Position: PRESIDENT
Credential: DMD
Phone: 813-448-7828