Healthcare Provider Details

I. General information

NPI: 1669229209
Provider Name (Legal Business Name): SKP DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38034 MEDICAL CENTER AVE
ZEPHYRHILLS FL
33540-1383
US

IV. Provider business mailing address

32303 MAHOGANY VALLEY DR
WESLEY CHAPEL FL
33543-4127
US

V. Phone/Fax

Practice location:
  • Phone: 516-450-8358
  • Fax:
Mailing address:
  • Phone: 516-450-8358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: KRUNAL PANDHI
Title or Position: OFFICE MANAGER
Credential:
Phone: 516-450-8358