MEDICARE: ADAK-2 ENTERPRISES

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	1457719627	OTHER	FL	DENTIST

General Provider Information

NPI Number	:	1861190480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAK-2 ENTERPRISES

Provider Business Mailing Address
First Line	:	6415 SHELDON RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3102
Country	:	US
Telephone Number	:	813-880-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	6415 SHELDON RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3102
Country	:	US
Telephone Number	:	813-880-0100
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	ASHLEY CHANDLER
Credential	:
Telephone Number	:	863-640-0555

Provider Enumeration Date	:	02/22/2023
Last Update Date	:	02/22/2023

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Directions to “ADAK-2 ENTERPRISES ” Practice Location

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