Healthcare Provider Details

I. General information

NPI: 1730747395
Provider Name (Legal Business Name): MICHAEL A. PIKOS, DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11940 SHELDON ROAD
TAMPA FL
33626
US

IV. Provider business mailing address

2711 TAMPA ROAD
PALM HARBOR FL
34684
US

V. Phone/Fax

Practice location:
  • Phone: 727-877-0011
  • Fax:
Mailing address:
  • Phone: 727-786-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE DIAZ
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 727-709-1275