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General NPI Number Information
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NPI Number | 1720802465
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Entity Type | Organization
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Legal Business Name | PHOENIX DENTAL, PLLC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 3415 W FLETCHER AVE
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City | TAMPA
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State | FL
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Zip | 33618-2813
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Country | US
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Telephone | 813-419-3808
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Fax |
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Provider Business Mailing Address
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Address Line | 13011 TERRACE BROOK PL
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City | TEMPLE TERRACE
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State | FL
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Zip | 33637-3009
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Country | US
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Telephone | 813-404-7613
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. MASROOR AHMED SHARIFF
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Credential | DMD
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Telephone | 813-419-3808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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