MEDICARE: MDS SAINT PETERSBURG PLLC

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	:	1962208801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDS SAINT PETERSBURG PLLC

Provider Business Mailing Address
First Line	:	2699 1ST AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33713-8703
Country	:	US
Telephone Number	:	727-322-0505
Fax Number	:

Provider Business Practice Location Address
First Line	:	2699 1ST AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33713-8703
Country	:	US
Telephone Number	:	727-322-0505
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	REMAL PATEL
Credential	:	DMD
Telephone Number	:	727-322-0505

Provider Enumeration Date	:	02/21/2025
Last Update Date	:	02/21/2025

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