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General NPI Number Information
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NPI Number | 1134254139
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Entity Type | Organization
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Legal Business Name | ALAN D SHOOPAK DMD ORTHODONTIC GROUP VIII LLC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 12920 CORTEZ BLVD
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City | SPRING HILL
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State | FL
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Zip | 34613-6803
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Country | US
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Telephone | 352-683-6116
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Fax | 352-683-1925
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Provider Business Mailing Address
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Address Line | 6311 4TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33702-7511
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Country | US
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Telephone | 727-522-5599
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Fax | 727-526-1702
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALAN D. SHOOPAK
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Credential | D.M.D.
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Telephone | 727-522-5599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State | FL
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