MEDICARE: DENTAL ASSOCIATES OF SUNCITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN19312	FL

General Provider Information

NPI Number	:	1023389699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL ASSOCIATES OF SUNCITY

Provider Business Mailing Address
First Line	:	4040 UPPER CREEK DRIVE
Second Line	:
City	:	SUNCITY CENTER
State	:	FL
Zip	:	33573
Country	:	US
Telephone Number	:	813-633-3339
Fax Number	:	813-633-3313

Provider Business Practice Location Address
First Line	:	4040 UPPER CREEK DR
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6844
Country	:	US
Telephone Number	:	813-633-3339
Fax Number	:	813-633-3313

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ANTONIA MARIE DELAROSA
Credential	:
Telephone Number	:	813-633-3339

Provider Enumeration Date	:	01/13/2012
Last Update Date	:	01/13/2012

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