Healthcare Provider Details

I. General information

NPI: 1841655610
Provider Name (Legal Business Name): OHC DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 CHANNELSIDE DR SUITE 2102
TAMPA FL
33602-4229
US

IV. Provider business mailing address

912 CHANNELSIDE DR SUITE 2102
TAMPA FL
33602-4229
US

V. Phone/Fax

Practice location:
  • Phone: 813-906-6737
  • Fax:
Mailing address:
  • Phone: 813-906-6737
  • 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: MONICA SANCHEZ-DIU
Title or Position: OWNER
Credential: DDS
Phone: 813-906-6737