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General NPI Number Information
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NPI Number | 1508486200
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL DESIGNS, LLC
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 17735 HUNTING BOW CIRCLE APARTMENT, SUITE, UNIT, BUILDING, FLOOR
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City | LUTZ
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State | FL
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Zip | 33558
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Country | US
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Telephone | 813-995-6178
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Fax |
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Provider Business Mailing Address
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Address Line | 17735 HUNTING BOW CIRCLE APARTMENT, SUITE, UNIT, BUILDING, FLOOR
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City | LUTZ
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State | FL
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Zip | 33558
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Country | US
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Telephone | 813-995-6178
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | SHEETAL SURYAWANSHI
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Credential | DMD
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Telephone | 813-995-6178
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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 |
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License Number State |
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