1568030815 NPI number — FRANCISCO H BEZERRA DDS PA

Table of content: (NPI 1568030815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568030815 NPI number — FRANCISCO H BEZERRA DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANCISCO H BEZERRA DDS 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:
1568030815
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2242 ASHLEY OAKS CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESLEY CHAPEL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33544-6404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-991-5300
Provider Business Mailing Address Fax Number:
888-520-4252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 PONCE DE LEON BLVD STE 401
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33756-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-310-0410
Provider Business Practice Location Address Fax Number:
727-339-4020
Provider Enumeration Date:
06/14/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BEZERRA
Authorized Official First Name:
FRANCISCO
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-991-5300

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112041901 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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