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General NPI Number Information
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NPI Number | 1649658527
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Entity Type | Organization
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Legal Business Name | INTL. DENTAL GROUP OF FLORIDA
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 09/28/2015
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Provider Practice Location Address
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Address Line | 520 OAKFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-5743
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Country | US
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Telephone | 813-661-1600
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Fax | 813-661-1615
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Provider Business Mailing Address
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Address Line | 520 OAKFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-5743
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Country | US
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Telephone | 813-661-1600
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Fax | 813-661-1615
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Authorized Official
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Title or Position | DOCTOR, DMD/PRESIDENT
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Name | DR. ELIZABETH PEREZ
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Credential | DMD
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Telephone | 813-661-1600
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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 | DN15530
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License Number State | FL
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