Organization
KOOL KIDZ PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROXANN RUSSELL AVES DDS (PED. DENTIST/MANAGING PARTNER)
(813) 885-4501
Entity
Organization
Contact information
Practice address
7712 W WATERS AVE, TAMPA, FL 33615-1813
(813) 885-4501
(813) 885-5410
Mailing address
7712 W WATERS AVE, TAMPA, FL 33615-1813
(813) 885-4501
(813) 885-5410
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN18794
FL
Other
Enumeration date
03/29/2011
Last updated
03/29/2011
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