Healthcare Provider Details

I. General information

NPI: 1366557233
Provider Name (Legal Business Name): DENNIS DEMIRJIAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6526 GUNN HWY
TAMPA FL
33625-4022
US

IV. Provider business mailing address

6526 GUNN HWY
TAMPA FL
33625-4022
US

V. Phone/Fax

Practice location:
  • Phone: 813-374-2290
  • Fax: 813-374-9048
Mailing address:
  • Phone: 813-374-2290
  • Fax: 813-374-9048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN15009
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2832
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: