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General NPI Number Information
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NPI Number | 1376087742
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Entity Type | Organization
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Legal Business Name | INNOVATIVE DENTAL SOLUTION OF BRANDON,LLC
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 926 W LUMSDEN RD
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City | BRANDON
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State | FL
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Zip | 33511-6281
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Country | US
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Telephone | 813-438-8728
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Fax | 813-438-8730
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Provider Business Mailing Address
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Address Line | 926 W LUMSDEN RD
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City | BRANDON
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State | FL
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Zip | 33511-6281
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Country | US
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Telephone | 813-438-8728
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Fax | 813-438-8730
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Authorized Official
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Title or Position | INSURANCE SPECIALIST
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Name | SYLVIA L MILLER
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Credential |
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Telephone | 321-431-2208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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