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General NPI Number Information
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NPI Number | 1134531270
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Entity Type | Organization
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Legal Business Name | KIDZONE DENTISTRY PA
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Dates
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Enumeration Date | 05/23/2014
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 13127 KINGS LAKE DR UNIT 101
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City | GIBSONTON
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State | FL
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Zip | 33534-3958
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Country | US
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Telephone | 813-677-3047
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Fax | 813-284-7959
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Provider Business Mailing Address
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Address Line | 6815 SCENIC DR
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City | APOLLO BEACH
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State | FL
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Zip | 33572-1543
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Country | US
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Telephone | 813-408-4634
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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. MOUNIKA FALEMBAN
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Credential | BDS, MDS
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Telephone | 813-408-4634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN18289
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN18289
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License Number State | FL
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