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General NPI Number Information
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NPI Number | 1619833159
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Entity Type | Organization
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Legal Business Name | FIRST CLASS KIDS PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 1779 S KINGS AVE
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City | BRANDON
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State | FL
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Zip | 33511-6220
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Country | US
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Telephone | 813-554-5437
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Fax | 813-554-5477
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Provider Business Mailing Address
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Address Line | 1779 S KINGS AVE
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City | BRANDON
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State | FL
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Zip | 33511-6220
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Country | US
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Telephone | 813-554-5437
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Fax | 813-554-5477
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Authorized Official
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Title or Position | OWNER/PEDIATRIC DENTIST
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Name | DOROTHY THEOGENE
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Credential | DDS
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Telephone | 954-610-9441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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