# TAMPA BAY MAXILLOFACIAL SURGERY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164932356
- **Authorized official:** DR. ROBERT J YU DMD (MANAGING MEMBER)
- **Authorized official phone:** (727) 894-1442

## Contact information

- **Practice address:** 2140 16TH ST N, ST PETERSBURG, FL 33704-3924
- **Practice address phone:** (727) 894-1442
- **Mailing address:** 4021 LAS PALMAS WAY, SARASOTA, FL 34238-4531
- **Mailing address phone:** (727) 424-5540

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |
| 261QD0000X | Dental Clinic/Center | — | NULL | — |
| 261QS0112X | Oral and Maxillofacial Surgery Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 10/03/2017
- **Last updated:** 06/21/2019