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General NPI Number Information
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NPI Number | 1497454946
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF LUTZ, LLC
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Dates
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Enumeration Date | 02/23/2023
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Last Update Date | 03/10/2023
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Provider Practice Location Address
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Address Line | 4675 VAN DYKE RD
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City | LUTZ
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State | FL
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Zip | 33558-4880
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Country | US
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Telephone | 813-591-2200
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Fax | 813-374-8329
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Provider Business Mailing Address
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Address Line | 4675 VAN DYKE RD
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City | LUTZ
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State | FL
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Zip | 33558-4880
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Country | US
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Telephone | 813-591-2200
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Fax | 813-374-8329
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SASHA MARTINEZ
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Credential |
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Telephone | 813-591-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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