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Organization
TARPON SHORES DENTAL, LLC
Active
Organization
TARPON SHORES DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHANDEEV ROMESH WEERASOORIYA DMD (MANAGER)
(941) 474-9548
Entity
Organization
Contact information
Practice address
544 JOHN RINGLING BLVD, SARASOTA, FL 34236-1430
(941) 388-4114
Mailing address
1314 E VENICE AVE, SUITE F, VENICE, FL 34285-7160
(941) 488-7910
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
511613837863
MEDICARE CCN
FL
Enumeration date
01/05/2013
Last updated
11/22/2016
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