Healthcare Provider Details

I. General information

NPI: 1053649459
Provider Name (Legal Business Name): CORNERSTONE DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
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 TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11975
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN A FRANKLIN
Title or Position: PRESIDENT
Credential: DMD
Phone: 813-448-7828