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General NPI Number Information
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NPI Number | 1033549266
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Entity Type | Organization
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Legal Business Name | TAMPA BAY DENTAL SLEEP THERAPY, LLC
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Dates
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Enumeration Date | 11/25/2013
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Last Update Date | 11/25/2013
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Provider Practice Location Address
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Address Line | 330 S LINE AVE
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City | INVERNESS
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State | FL
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Zip | 34452-4606
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Country | US
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Telephone | 813-690-1736
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Fax |
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Provider Business Mailing Address
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Address Line | 12948 SERONERA VALLEY CT
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City | SPRING HILL
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State | FL
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Zip | 34610-7667
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Country | US
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Telephone | 813-690-1736
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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. FADI Y FARES
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Credential | D.M.D.
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Telephone | 813-690-1736
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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 | DN15084
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License Number State | FL
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