MEDICARE: DENTURE PLACE, LLC

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	:	1851981195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTURE PLACE, LLC

Provider Business Mailing Address
First Line	:	8406 WILSKY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8406 WILSKY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1515
Country	:	US
Telephone Number	:	813-291-7227
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KENIANN SIERRA
Credential	:
Telephone Number	:	813-291-7227

Provider Enumeration Date	:	01/20/2021
Last Update Date	:	11/07/2025

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