Organization
CHILDREN AND TEEN DENTAL GROUP OF FLORIDA
Active
Parent organization
CHILDREN AND TEEN DENTAL GROUP OF FLORIDA
Other names
Pediatric Dentistry of Brandon
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHILDREN AND TEEN DENTAL GROUP OF FLORIDA
Authorized official
NICOLE CARIDE (CREDENTIALING MGR)
(727) 784-2721
Entity
Organization
Contact information
Practice address
3413 S KINGS AVE STE 200, BRANDON, FL 33511-7780
(813) 685-0804
(813) 681-7213
Mailing address
2300 LAKEVIEW PKWY STE 250, ALPHARETTA, GA 30009-3954
(470) 207-3264
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
08/11/2021
Last updated
01/21/2025
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