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General NPI Number Information
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NPI Number | 1003233396
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Entity Type | Organization
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Legal Business Name | ADVENTURE SMILES PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 5714 21ST AVE W
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City | BRADENTON
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State | FL
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Zip | 34209-5606
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Country | US
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Telephone | 941-792-6272
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Fax |
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Provider Business Mailing Address
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Address Line | 5714 21ST AVE W
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City | BRADENTON
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State | FL
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Zip | 34209-5606
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Country | US
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Telephone | 941-792-6272
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRYAN JOSEPH MORGAN
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Credential | DDS
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Telephone | 941-792-6272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 19243
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License Number State | FL
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