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General NPI Number Information
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NPI Number | 1508704784
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Entity Type | Organization
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Legal Business Name | GOLDEN YEARS DENTISTRY PLLC
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Dates
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Enumeration Date | 03/23/2026
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 3172 FOUNTAINHEAD DR
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City | LARGO
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State | FL
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Zip | 33770-4232
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Country | US
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Telephone | 601-466-3617
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Fax |
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Provider Business Mailing Address
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Address Line | 3172 FOUNTAINHEAD DR
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City | LARGO
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State | FL
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Zip | 33770-4232
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MARY MABRY
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Credential | DMD
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Telephone | 601-466-3617
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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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