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General NPI Number Information
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NPI Number | 1902499338
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Entity Type | Organization
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Legal Business Name | THE TOOTH SHOP OF OCALA, LLC
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Dates
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Enumeration Date | 02/17/2021
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 25520 STATE ROAD 46
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City | SORRENTO
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State | FL
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Zip | 32776-9526
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Country | US
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Telephone | 352-735-2211
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Fax | 352-735-5844
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Provider Business Mailing Address
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Address Line | 8205 CONWAY RD
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City | YALAHA
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State | FL
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Zip | 34797-3402
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Country | US
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Telephone | 352-391-4231
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Fax | 352-735-5844
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. DANA SYSKA
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Credential |
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Telephone | 352-732-2458
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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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