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General NPI Number Information
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NPI Number | 1609567056
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Entity Type | Organization
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Legal Business Name | TAMPA BAY SMILES, INC.
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 5438 LAND O LAKES BLVD
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City | LAND O LAKES
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State | FL
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Zip | 34639-3413
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Country | US
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Telephone | 813-929-0996
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Fax | 813-929-0996
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Provider Business Mailing Address
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Address Line | 1307 MERRY WATER DR
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City | LUTZ
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State | FL
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Zip | 33548-4810
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Country | US
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Telephone | 813-857-8696
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Fax | 813-929-0996
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JASON M MOORE
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Credential | D.M.D.
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Telephone | 813-857-8696
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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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