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General NPI Number Information
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NPI Number | 1720597842
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Entity Type | Organization
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Legal Business Name | CARR PEDIATRIC DENTISTRY, PA
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Dates
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Enumeration Date | 09/20/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 11936 BOYETTE RD
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City | RIVERVIEW
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State | FL
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Zip | 33569-5601
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Country | US
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Telephone | 813-672-3368
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Fax |
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Provider Business Mailing Address
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Address Line | 11936 BOYETTE RD
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City | RIVERVIEW
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State | FL
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Zip | 33569-5601
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Country | US
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Telephone | 813-672-3368
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NATALIE CARR BUSTILLO
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Credential | DDS, MS
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Telephone | 813-672-3368
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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 | FL
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