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General NPI Number Information
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NPI Number | 1891465779
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Entity Type | Organization
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Legal Business Name | DENTISTRY OF NORTH PORT PA
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 13801 TAMIAMI TRL STE B
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City | NORTH PORT
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State | FL
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Zip | 34287-2017
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Country | US
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Telephone | 941-200-5812
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Fax |
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Provider Business Mailing Address
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Address Line | 13801 TAMIAMI TRL STE B
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City | NORTH PORT
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State | FL
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Zip | 34287-2017
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Country | US
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Telephone | 941-200-5812
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. ROSA HERNANDEZ
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Credential | DMD
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Telephone | 754-610-9880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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