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General NPI Number Information
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NPI Number | 1467880070
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL AT CONNERTON
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 7918 LAND O LAKES BLVD SUITE 101
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City | LAND O LAKES
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State | FL
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Zip | 34638
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Country | US
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Telephone | 813-929-9800
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Fax | 813-929-9815
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Provider Business Mailing Address
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Address Line | 7918 LAND O LAKES BLVD SUITE 101
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City | LAND O LAKES
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State | FL
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Zip | 34638-5705
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Country | US
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Telephone | 813-929-9800
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Fax | 813-929-9815
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CATHERINE LAND
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Credential |
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Telephone | 813-929-9800
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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 | DN18381
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN17707
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License Number State | FL
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