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General NPI Number Information
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NPI Number | 1598969016
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Entity Type | Organization
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Legal Business Name | FAMILY AND COSMETIC DENTISTRY OF HOLIDAY
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4916 MILE STRETCH DR
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City | HOLIDAY
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State | FL
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Zip | 34690-4333
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Country | US
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Telephone | 727-938-2866
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Fax |
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Provider Business Mailing Address
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Address Line | 4916 MILE STRETCH DR
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City | HOLIDAY
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State | FL
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Zip | 34690-4333
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Country | US
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Telephone | 727-938-2866
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AFSANEH K DEAN
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Credential | DMD
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Telephone | 727-938-2866
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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 | DN16150
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License Number State | FL
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