MEDICARE: DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA, 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1124337084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA, PA

Provider Business Mailing Address
First Line	:	136 4TH ST N STE 201
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-3889
Country	:	US
Telephone Number	:	727-800-8026
Fax Number	:	727-304-3164

Provider Business Practice Location Address
First Line	:	4696 FRUITVILLE RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34232-1825
Country	:	US
Telephone Number	:	941-952-1222
Fax Number	:	941-377-9731

Authorized Official
Title or Position	:	NATIONAL DIRECTOR OF RCM
Name	:	ROSA LESSO
Credential	:
Telephone Number	:	714-571-3471

Provider Enumeration Date	:	09/27/2010
Last Update Date	:	02/02/2024

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