Healthcare Provider Details

I. General information

NPI: 1881503340
Provider Name (Legal Business Name): VICE ENDODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 W FLETCHER AVE
TAMPA FL
33618-2810
US

IV. Provider business mailing address

11941 WANDSWORTH DR
TAMPA FL
33626-2612
US

V. Phone/Fax

Practice location:
  • Phone: 616-540-2584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN THOMAS VICE
Title or Position: MANAGING MEMBER
Credential: DMD
Phone: 616-540-2584