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General NPI Number Information
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NPI Number | 1952502742
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Entity Type | Organization
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Legal Business Name | DENTAL EXCELLENCE AT FISHHAWK
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 5486 LITHIA PINECREST RD
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City | LITHIA
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State | FL
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Zip | 33547-2853
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Country | US
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Telephone | 813-571-5555
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Fax | 813-571-5559
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Provider Business Mailing Address
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Address Line | 5486 LITHIA PINECREST RD
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City | LITHIA
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State | FL
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Zip | 33547-2853
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Country | US
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Telephone | 813-571-5555
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Fax | 813-571-5559
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Authorized Official
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Title or Position | DMD
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Name | DR. RICHARD MICHAEL KERNAGIS
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Credential |
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Telephone | 813-571-5555
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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 | DN15191
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License Number State | FL
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