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General NPI Number Information
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NPI Number | 1194119255
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Entity Type | Organization
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Legal Business Name | A FAMILY DENTIST PA
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 5153 MARINE PKWY
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652
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Country | US
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Telephone | 727-645-6932
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Fax | 727-807-3397
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Provider Business Mailing Address
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Address Line | 5153 MARINE PKWY
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652
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Country | US
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Telephone | 727-645-6932
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Fax | 727-807-3397
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. CRISTEN MARIE MENDOZA
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Credential | DMD
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Telephone | 727-808-7886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN18780
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License Number State | FL
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