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General NPI Number Information
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NPI Number | 1023738044
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Entity Type | Organization
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Legal Business Name | LITHIA PINECREST SMILES PA
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 716 S OAKWOOD AVE
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City | BRANDON
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State | FL
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Zip | 33511-6124
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Country | US
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Telephone | 813-285-4084
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Fax | 813-285-4951
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Provider Business Mailing Address
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Address Line | 716 S OAKWOOD AVE
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City | BRANDON
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State | FL
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Zip | 33511-6124
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Country | US
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Telephone | 813-285-4084
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Fax | 813-285-4951
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Authorized Official
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Title or Position | VP
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Name | ANDREW CROUCH
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Credential |
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Telephone | 321-872-8820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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