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General NPI Number Information
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NPI Number | 1265355788
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Entity Type | Organization
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Legal Business Name | PP SD DENTISTRY LLC
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Dates
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Enumeration Date | 08/01/2026
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Last Update Date | 08/01/2026
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Provider Practice Location Address
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Address Line | 4333 S TAMIAMI TRL STE D
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City | SARASOTA
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State | FL
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Zip | 34231-3461
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Country | US
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Telephone | 941-415-9779
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Fax | 941-415-9780
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Provider Business Mailing Address
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Address Line | 6951 SCRUB JAY DR
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City | SARASOTA
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State | FL
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Zip | 34241-5223
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Country | US
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Telephone | 954-383-8362
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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. PHENNATDA POLPORNVITOON
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Credential | DMD
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Telephone | 954-383-8362
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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 |
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License Number State |
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