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General NPI Number Information
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NPI Number | 1528072006
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Entity Type | Organization
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Legal Business Name | DEVITO ORTHODONTICS, PA
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2745 STATE ROAD 580 SUITE 103
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City | CLEARWATER
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State | FL
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Zip | 33761-3359
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Country | US
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Telephone | 727-725-4744
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Fax | 727-725-1561
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Provider Business Mailing Address
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Address Line | 2745 STATE ROAD 580 SUITE 103
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City | CLEARWATER
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State | FL
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Zip | 33761-3359
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Country | US
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Telephone | 727-725-4744
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Fax | 727-725-1561
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Authorized Official
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Title or Position | PRES/VP/SEC/TREAS
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Name | DR. MICHAEL J. DEVITO
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Credential | D.D.S.
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Telephone | 727-725-4744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN10472
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License Number State | FL
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