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General NPI Number Information
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NPI Number | 1154102523
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Entity Type | Organization
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Legal Business Name | PINELLAS PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 10/11/2023
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 4020 PORTSMOUTH RD
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City | LARGO
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State | FL
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Zip | 33771-3318
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Country | US
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Telephone | 727-335-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 14699 113TH AVE
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City | LARGO
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State | FL
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Zip | 33774-4309
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Country | US
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Telephone | 863-808-6124
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. NANCY MONTGOMERY-EASLEY
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Credential | DMD
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Telephone | 863-808-6124
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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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