MEDICARE: ALAN D. SHOOPAK, D.M.D., P.A.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1649108093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAN D. SHOOPAK, D.M.D., P.A.

Provider Business Mailing Address
First Line	:	6311 4TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33702-7511
Country	:	US
Telephone Number	:	727-522-5599
Fax Number	:	813-315-6768

Provider Business Practice Location Address
First Line	:	10083 US HIGHWAY 19
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-3742
Country	:	US
Telephone Number	:	813-388-8452
Fax Number	:	813-315-6768

Authorized Official
Title or Position	:	OWNER
Name	:	ALAN DAVID SHOOPAK
Credential	:
Telephone Number	:	727-522-5599

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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