Organization
BAY AREA MODERN DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVO BUSHATI DMD (DENTIST)
(727) 547-8227
Entity
Organization
Contact information
Practice address
5299 PARK BLVD N, PINELLAS PARK, FL 33781-3418
(727) 547-8227
Mailing address
506 20TH AVE NE, ST PETERSBURG, FL 33704-4622
(727) 686-1808
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
04/28/2021
Last updated
04/28/2021
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