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General NPI Number Information
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NPI Number | 1770309726
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Entity Type | Organization
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Legal Business Name | DENTAL OFFICE OF TAMPA LLC
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 3955 MORAN RD
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City | TAMPA
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State | FL
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Zip | 33618-4622
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Country | US
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Telephone | 727-519-4588
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Fax | 727-738-1466
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Provider Business Mailing Address
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Address Line | 1044 BELCHER RD
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City | DUNEDIN
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State | FL
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Zip | 34698-5680
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Country | US
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Telephone | 727-738-8845
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Fax |
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | NIKKI BLANTON
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Credential |
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Telephone | 727-738-8845
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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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