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General NPI Number Information
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NPI Number | 1588796965
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL CARE OF CLEARWATER P.A.
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 3690 E BAY DR SUITE L
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City | LARGO
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State | FL
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Zip | 33771-5903
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Country | US
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Telephone | 727-535-5583
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Fax |
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Provider Business Mailing Address
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Address Line | 3690 E BAY DR SUITE L
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City | LARGO
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State | FL
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Zip | 33771-5903
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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 | VP INSURANCE PLAN MANAGEMENT
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Name | MIKE COLE
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Credential |
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Telephone | 727-726-1611
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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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