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General NPI Number Information
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NPI Number | 1710316336
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Entity Type | Organization
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Legal Business Name | TRINITY ENDODONTICS
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 1602 S. FLORIDA AVE, STE #1
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City | LAKELAND
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State | FL
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Zip | 33803
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Country | US
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Telephone | 863-413-9773
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Fax | 863-688-2960
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Provider Business Mailing Address
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Address Line | 1602 S. FLORIDA AVE, STE #1
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City | LAKELAND
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State | FL
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Zip | 33803
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Country | US
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Telephone | 863-413-9773
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Fax | 863-688-2960
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Authorized Official
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Title or Position | ENDODONTIST
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Name | DR. TERRYL M CRAWFORD
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Credential | D.M.D.,M.S.D.
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Telephone | 863-413-9773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | DN16500
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License Number State | FL
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