MEDICARE: ADVANCED DENTAL CARE OF TAMPA PA

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

General Provider Information

NPI Number	:	1922130319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED DENTAL CARE OF TAMPA PA

Provider Business Mailing Address
First Line	:	3716 W NEPTUNE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3716 W NEPTUNE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5119
Country	:	US
Telephone Number	:	813-253-3343
Fax Number	:

Authorized Official
Title or Position	:	INSURANCE DIRECTOR
Name	:	MIKE COLE
Credential	:
Telephone Number	:	727-726-1611

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/30/2010

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Directions to “ADVANCED DENTAL CARE OF TAMPA PA ” Practice Location

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