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General NPI Number Information
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NPI Number | 1043354574
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Entity Type | Organization
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Legal Business Name | PRESTIGE DENTAL
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Dates
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Enumeration Date | 02/17/2007
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Last Update Date | 06/28/2010
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Provider Practice Location Address
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Address Line | 8408 S TAMIAMI TRL
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City | SARASOTA
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State | FL
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Zip | 34238-2936
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Country | US
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Telephone | 941-918-1416
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Fax | 941-918-9726
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Provider Business Mailing Address
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Address Line | 8408 S TAMIAMI TRL
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City | SARASOTA
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State | FL
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Zip | 34238-2936
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Country | US
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Telephone | 941-918-1416
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Fax | 941-918-9726
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Authorized Official
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Title or Position | DATA INPUT
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Name | MRS. ELIZABETH MARGARETHA SIMPSON
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Credential |
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Telephone | 941-918-1416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN13189
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN16207
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License Number State | FL
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