Healthcare Provider Details

I. General information

NPI: 1164339396
Provider Name (Legal Business Name): TAMPA ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 EHRLICH RD STE 112
TAMPA FL
33624-2049
US

IV. Provider business mailing address

5121 EHRLICH RD STE 112
TAMPA FL
33624-2049
US

V. Phone/Fax

Practice location:
  • Phone: 813-825-7750
  • Fax:
Mailing address:
  • Phone: 813-825-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DENNIS DEMIRJIAN
Title or Position: PRESIDENT
Credential: DMD
Phone: 813-956-6722