MEDICARE: TAMPA BAY MODERN DAY SMILES

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	DN19054	FL

General Provider Information

NPI Number	:	1184070658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA BAY MODERN DAY SMILES

Provider Business Mailing Address
First Line	:	7002 SHELDON RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2305
Country	:	US
Telephone Number	:	813-890-0044
Fax Number	:	813-884-6515

Provider Business Practice Location Address
First Line	:	7002 SHELDON RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2305
Country	:	US
Telephone Number	:	813-890-0044
Fax Number	:	813-884-6515

Authorized Official
Title or Position	:	PRESIDENT
Name	:	REMAL PATEL
Credential	:	DMD
Telephone Number	:	727-322-0505

Provider Enumeration Date	:	05/13/2016
Last Update Date	:	05/13/2016

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