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General NPI Number Information
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NPI Number | 1750055182
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Entity Type | Organization
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Legal Business Name | CHILDREN AND TEEN DENTAL GROUP OF FLORIDA
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 31067 US HIGHWAY 19 N
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City | PALM HARBOR
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State | FL
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Zip | 34684-4416
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Country | US
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Telephone | 727-304-5483
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Fax | 727-260-4098
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Provider Business Mailing Address
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Address Line | 2300 LAKEVIEW PKWY STE 250
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City | ALPHARETTA
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State | GA
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Zip | 30009-3954
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Country | US
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Telephone | 470-207-3264
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRIAN SMITH
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Credential |
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Telephone | 770-231-5348
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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 |
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License Number State |
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Taxonomy #2
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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 |
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #4
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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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