Healthcare Provider Details

I. General information

NPI: 1528294584
Provider Name (Legal Business Name): DEREK DUGGAN DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 W HILLSBOROUGH AVE
TAMPA FL
33614-6053
US

IV. Provider business mailing address

2702 W HILLSBOROUGH AVE
TAMPA FL
33614-6053
US

V. Phone/Fax

Practice location:
  • Phone: 813-365-3021
  • Fax:
Mailing address:
  • Phone: 813-365-3021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number20327
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: