1982178612 NPI number — WESLEY CHAPEL SMILES DENTISTRY, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982178612 NPI number — WESLEY CHAPEL SMILES DENTISTRY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESLEY CHAPEL SMILES DENTISTRY, 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:
1982178612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 920050
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75392-0050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-845-8500
Provider Business Mailing Address Fax Number:
303-952-0892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25464 SIERRA CENTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUTZ
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33559-7322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-296-2028
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2019

Additional Information

Authorized Official

Authorized Official Last Name:
PHAM
Authorized Official First Name:
MINH
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER/DDS
Authorized Official Telephone Number:
813-296-2028

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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