Organization
PERIODONTAL ASSOCIATES OF TAMPA BAY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN TODD VANAELST D.M.D (PERIODONTIST)
(813) 988-1103
Entity
Organization
Contact information
Practice address
5208 E FOWLER AVE STE F, TEMPLE TERRACE, FL 33617-2152
(813) 988-1103
(813) 985-1524
Mailing address
5208 E FOWLER AVE STE F, TEMPLE TERRACE, FL 33617-2152
(813) 988-1103
(813) 985-1524
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DN16867
FL
Other
Enumeration date
06/16/2011
Last updated
06/16/2011
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