Healthcare Provider Details

I. General information

NPI: 1922803659
Provider Name (Legal Business Name): SRQ DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5670 FRUITVILLE RD
SARASOTA FL
34232-6407
US

IV. Provider business mailing address

832 FREELING DR
SARASOTA FL
34242-1025
US

V. Phone/Fax

Practice location:
  • Phone: 941-231-0225
  • Fax:
Mailing address:
  • Phone: 512-663-7611
  • 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: DR. DANIELLE DAVIS
Title or Position: PARTNER/OWNER
Credential: DMD
Phone: 512-663-7611