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NPI Code Detail

MEDICARE: LITHIA PINECREST SMILES PA

MEDICARE: LITHIA PINECREST SMILES PA
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
11223E0200XEndodontics
21223P0300XPeriodontics
3122300000XDentist

General Provider Information

NPI Number : 1023738044
Entity Type Code : Organization
Provider Name (Legal Business Name) : LITHIA PINECREST SMILES PA
Provider Business Mailing Address
First Line : 716 S OAKWOOD AVE
Second Line :
City : BRANDON
State : FL
Zip : 33511-6124
Country : US
Telephone Number : 813-285-4084
Fax Number : 813-285-4951
Provider Business Practice Location Address
First Line : 716 S OAKWOOD AVE
Second Line :
City : BRANDON
State : FL
Zip : 33511-6124
Country : US
Telephone Number : 813-285-4084
Fax Number : 813-285-4951
Authorized Official
Title or Position : VP
Name : ANDREW CROUCH
Credential :
Telephone Number : 321-872-8820
Provider Enumeration Date : 08/30/2022
Last Update Date : 08/30/2022

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Directions to “LITHIA PINECREST SMILES PA ” Practice Location

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