1689712127 NPI number — THE DENTIST PLACE

Table of content: (NPI 1689712127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689712127 NPI number — THE DENTIST PLACE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DENTIST PLACE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE DENTIST PLACE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689712127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27001 U.S. HIGHWAY 19 N
Provider Second Line Business Mailing Address:
SUITE 8520
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-799-0650
Provider Business Mailing Address Fax Number:
727-797-9273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27001 U.S. HIGHWAY 19 N
Provider Second Line Business Practice Location Address:
SUITE 8520
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-799-0650
Provider Business Practice Location Address Fax Number:
727-797-9273
Provider Enumeration Date:
02/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RASHID
Authorized Official First Name:
MURAD
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL DENTIST
Authorized Official Telephone Number:
727-799-0650

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DN 0008198 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223S0112X , with the licence number: DN 0008198 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)