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General NPI Number Information
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NPI Number | 1154751451
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Entity Type | Organization
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Legal Business Name | BRANDON COSMETIC AND FAMILY DENTISTRY
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Dates
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Enumeration Date | 11/22/2013
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 1127 PROFESSIONAL PARK DR
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City | BRANDON
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State | FL
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Zip | 33511-4887
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Country | US
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Telephone | 813-662-4853
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Fax | 813-662-4854
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Provider Business Mailing Address
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Address Line | 1127 PROFESSIONAL PARK DR
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City | BRANDON
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State | FL
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Zip | 33511-4887
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Country | US
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Telephone | 813-662-4853
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Fax | 813-662-4854
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Authorized Official
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Title or Position | DENTIST
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Name | GIOVANNI SOLANO
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Credential | DDS
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Telephone | 813-662-4853
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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 | 17353
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License Number State | FL
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