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General NPI Number Information
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NPI Number | 1104637909
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Entity Type | Organization
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Legal Business Name | WCDAK ENTERPRISES LLC
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 3737 MARYWEATHER LN STE 101
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-7779
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Country | US
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Telephone | 813-880-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 6415 SHELDON RD
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City | TAMPA
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State | FL
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Zip | 33615-3102
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ASHLEY CHANDLER
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Credential |
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Telephone | 863-644-0430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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