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Organization
TAMPA BAY MAXILLOFACIAL SURGERY, PLLC
Active
Organization
TAMPA BAY MAXILLOFACIAL SURGERY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT J YU DMD (MANAGING MEMBER)
(727) 894-1442
Entity
Organization
Contact information
Practice address
2140 16TH ST N, ST PETERSBURG, FL 33704-3924
(727) 894-1442
Mailing address
4021 LAS PALMAS WAY, SARASOTA, FL 34238-4531
(727) 424-5540
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
261QD0000X
Dental Clinic/Center
—
NULL
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
NULL
Other
Enumeration date
10/03/2017
Last updated
06/21/2019
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