MEDICARE: ADAM DIASTI DDS & ASSOCIATES P.C.

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		VA

General Provider Information

NPI Number	:	1366540270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAM DIASTI DDS & ASSOCIATES P.C.

Provider Business Mailing Address
First Line	:	2502 N ROCKY POINT DR
Second Line	:	SUITE 1000
City	:	TAMPA
State	:	FL
Zip	:	33607-1421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2502 N ROCKY POINT DR
Second Line	:	SUITE 1000
City	:	TAMPA
State	:	FL
Zip	:	33607-1421
Country	:	US
Telephone Number	:	813-288-1999
Fax Number	:

Authorized Official
Title or Position	:	GERERAL COUNSEL
Name	:	PATRICIA HUIE
Credential	:
Telephone Number	:	813-288-1999

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	08/22/2020

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