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General NPI Number Information
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NPI Number | 1245942705
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Entity Type | Organization
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Legal Business Name | TWO RIVERS FAMILY DENTAL LLC
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Dates
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Enumeration Date | 12/15/2022
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | 515 27TH ST E STE 6
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City | BRADENTON
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State | FL
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Zip | 34208-1879
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Country | US
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Telephone | 941-253-0175
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Fax |
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Provider Business Mailing Address
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Address Line | 5509 69TH PL E
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City | ELLENTON
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State | FL
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Zip | 34222-2627
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Country | US
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Telephone | 786-247-4916
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ANDRES ALBERTO
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Credential | DMD
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Telephone | 786-247-4916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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