MEDICARE: ALL DENTAL TAMPA, INC

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	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0026A	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1710393806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL DENTAL TAMPA, INC

Provider Business Mailing Address
First Line	:	3814 W BAY VISTA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1226
Country	:	US
Telephone Number	:	813-837-2380
Fax Number	:	813-837-2381

Provider Business Practice Location Address
First Line	:	3814 W BAY VISTA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1226
Country	:	US
Telephone Number	:	813-837-2380
Fax Number	:	813-837-2381

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. NADIA ONEAL
Credential	:	DDS
Telephone Number	:	813-837-2380

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	07/09/2014

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