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General NPI Number Information
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NPI Number | 1366035677
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Entity Type | Organization
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Legal Business Name | LILLYBASH DENTAL STUDIO PLLC
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Dates
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Enumeration Date | 02/17/2021
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Last Update Date | 02/17/2021
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Provider Practice Location Address
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Address Line | 11280 BOYETTE RD SUIT #101
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City | RIVERVIEW
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State | FL
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Zip | 33569
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Country | US
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Telephone | 813-567-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 4312 W SYLVAN RAMBLE ST
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City | TAMPA
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State | FL
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Zip | 33609-4316
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Country | US
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Telephone | 813-203-5291
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Fax |
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Authorized Official
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Title or Position | OWNER/ DOCTOR
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Name | DR. DANOOSH SHIRAVAND AMROOEI
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Credential | DMD
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Telephone | 813-203-5291
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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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