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General NPI Number Information
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NPI Number | 1275716458
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Entity Type | Organization
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Legal Business Name | GAETA DENTAL HEALTH PROFESSIONALS, PA
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 1865 HILLVIEW ST
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City | SARASOTA
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State | FL
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Zip | 34239-3606
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Country | US
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Telephone | 941-365-4500
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Fax | 941-365-5788
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Provider Business Mailing Address
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Address Line | 1865 HILLVIEW ST
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City | SARASOTA
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State | FL
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Zip | 34239-3606
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Country | US
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Telephone | 941-365-4500
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Fax | 941-365-5788
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Authorized Official
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Title or Position | INS COORD
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Name | AMY KROEGER
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Credential |
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Telephone | 217-540-5100
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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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