1891268413 NPI number — DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA PA

Table of content: (NPI 1891268413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891268413 NPI number — DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA PA
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:
Provider Other Organization Name Type Code:
6
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:
1891268413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9400 4TH ST N STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33702-2501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-800-8026
Provider Business Mailing Address Fax Number:
727-339-6543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2419 S BABCOCK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32901-5310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-956-7700
Provider Business Practice Location Address Fax Number:
321-956-8479
Provider Enumeration Date:
01/07/2019

Additional Information

Authorized Official

Authorized Official Last Name:
LESSO
Authorized Official First Name:
ROSA
Authorized Official Middle Name:
Authorized Official Title or Position:
NATIONAL DIRECTOR OF RCM
Authorized Official Telephone Number:
714-571-3471

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com