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General NPI Number Information
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NPI Number | 1720408917
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Entity Type | Organization
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Legal Business Name | DENTISTRY OF SARASOTA LLC
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Dates
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Enumeration Date | 04/26/2014
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Last Update Date | 04/07/2015
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Provider Practice Location Address
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Address Line | 3990 CLARK RD
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City | SARASOTA
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State | FL
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Zip | 34233-2363
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Country | US
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Telephone | 941-921-7055
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Fax | 941-923-0764
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Provider Business Mailing Address
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Address Line | 3990 CLARK RD
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City | SARASOTA
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State | FL
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Zip | 34233-2363
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Country | US
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Telephone | 941-921-7055
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Fax | 941-923-0764
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CINDY LOYAL
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Credential |
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Telephone | 941-921-7055
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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 | DN16194
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | DN16194
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License Number State | FL
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