Healthcare Provider Details

I. General information

NPI: 1659883759
Provider Name (Legal Business Name): ANTHONY MICHAEL PIKOS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 09/08/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 TAMPA RD
PALM HARBOR FL
34684-3312
US

IV. Provider business mailing address

1505 MISTY PLATEAU TRL
CLEARWATER FL
33765-1871
US

V. Phone/Fax

Practice location:
  • Phone: 727-786-1631
  • Fax: 727-785-8477
Mailing address:
  • Phone: 727-420-5291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6470
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN23085
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number23085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: