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General NPI Number Information
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NPI Number | 1588296883
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Entity Type | Organization
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Legal Business Name | TAVARES DENTAL PLLC
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Dates
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Enumeration Date | 02/05/2020
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 109 W MAIN ST
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City | TAVARES
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State | FL
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Zip | 32778-3809
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Country | US
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Telephone | 352-343-2821
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Fax |
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Provider Business Mailing Address
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Address Line | 838 HIGHWAY 466
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City | LADY LAKE
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State | FL
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Zip | 32159-3918
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Country | US
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Telephone | 801-971-2283
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ROBERT KENT HOWELL
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Credential | DMD
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Telephone | 801-971-2283
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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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