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General NPI Number Information
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NPI Number | 1548434087
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Entity Type | Organization
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Legal Business Name | LAUREL RIDGE DENTAL ASSOCIATES
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 7277 BEE RIDGE RD
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City | SARASOTA
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State | FL
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Zip | 34241-5969
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Country | US
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Telephone | 941-371-3006
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Fax | 941-371-6733
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Provider Business Mailing Address
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Address Line | 7277 BEE RIDGE RD
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City | SARASOTA
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State | FL
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Zip | 34241-5969
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Country | US
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Telephone | 941-371-3006
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Fax | 941-371-6733
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | MRS. MARY I PORTER
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Credential | D.M.D.
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Telephone | 941-371-3006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 13121
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 16728
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9698
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License Number State | FL
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