1417384975 NPI number — DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA

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 1417384975 NPI number — DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA
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:
PAUL A. PALO, DMD
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:
1417384975
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:
136 4TH ST N STE 201
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:
33701-3889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-800-8026
Provider Business Mailing Address Fax Number:
727-304-3164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 AVENUE F NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER HAVEN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33881-4132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-294-7605
Provider Business Practice Location Address Fax Number:
863-291-8440
Provider Enumeration Date:
09/30/2013

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 , with the licence number:  DN12379 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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