MEDICARE: TAMPA DENTAL CARE 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
1	122300000X	Dentist

General Provider Information

NPI Number	:	1033839519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA DENTAL CARE PA

Provider Business Mailing Address
First Line	:	104 E FLETCHER AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-3429
Country	:	US
Telephone Number	:	813-661-1800
Fax Number	:	813-864-7321

Provider Business Practice Location Address
First Line	:	104 E FLETCHER AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-3429
Country	:	US
Telephone Number	:	813-661-1800
Fax Number	:	813-864-7321

Authorized Official
Title or Position	:	DENTIST
Name	:	YUDANCY P GANGI
Credential	:	DDS
Telephone Number	:	813-661-1800

Provider Enumeration Date	:	09/02/2022
Last Update Date	:	09/02/2022

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