Healthcare Provider Details

I. General information

NPI: 1003411224
Provider Name (Legal Business Name): DENYS JOSE ROSA RHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 W WATERS AVE
TAMPA FL
33634-2222
US

IV. Provider business mailing address

4823 PURITAN CIR
TAMPA FL
33617-8352
US

V. Phone/Fax

Practice location:
  • Phone: 813-886-1800
  • Fax: 813-886-0519
Mailing address:
  • Phone: 813-409-0552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH27941
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: