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General NPI Number Information
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NPI Number | 1588091250
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Entity Type | Organization
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Legal Business Name | ST. LUKE'S DENTAL, PLC.
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 1908 LAND O LAKES BLVD SUITE 3
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City | LUTZ
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State | FL
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Zip | 33549-2914
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Country | US
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Telephone | 813-909-1555
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Fax | 813-909-1556
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Provider Business Mailing Address
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Address Line | 1908 LAND O LAKES BLVD SUITE 3
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City | LUTZ
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State | FL
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Zip | 33549-2914
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Country | US
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Telephone | 813-909-1555
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Fax | 813-909-1556
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL WAHBA
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Credential | DDS
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Telephone | 813-909-1555
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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 | DN15339
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License Number State | FL
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