Healthcare Provider Details

I. General information

NPI: 1316377641
Provider Name (Legal Business Name): DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date: 07/09/2020
Reactivation Date: 08/12/2020

III. Provider practice location address

1214 E VENICE AVE STE B
VENICE FL
34285-7165
US

IV. Provider business mailing address

136 4TH ST N STE 201
ST PETERSBURG FL
33701-3889
US

V. Phone/Fax

Practice location:
  • Phone: 941-484-8481
  • Fax: 941-485-6101
Mailing address:
  • Phone: 727-800-8026
  • Fax: 727-304-3164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN11595
License Number StateFL

VIII. Authorized Official

Name: ROSA LESSO
Title or Position: NATIONAL DIRECTOR OF RCM
Credential:
Phone: 714-571-3471