Healthcare Provider Details

I. General information

NPI: 1316673833
Provider Name (Legal Business Name): ESI DENTISTRY PALM HARBOR PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 04/30/2023
Certification Date: 04/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31980 US HIGHWAY 19 N
PALM HARBOR FL
34684-3730
US

IV. Provider business mailing address

31980 US HIGHWAY 19 N
PALM HARBOR FL
34684-3730
US

V. Phone/Fax

Practice location:
  • Phone: 727-842-6052
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. PARADIS ESFANDIARI
Title or Position: MANAGER
Credential: DDS
Phone: 727-772-1120