Healthcare Provider Details

I. General information

NPI: 1174437107
Provider Name (Legal Business Name): IDEAL DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6523 GUNN HWY
TAMPA FL
33625-4021
US

IV. Provider business mailing address

6523 GUNN HWY
TAMPA FL
33625-4021
US

V. Phone/Fax

Practice location:
  • Phone: 813-960-4744
  • Fax:
Mailing address:
  • Phone: 813-960-4744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MAUREEN GEORGY PALSO
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 813-376-0753