Organization
FAMILY DENTAL GROUP INC
Active
Parent organization
FAMILY DENTAL GROUP INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAMILY DENTAL GROUP INC
Authorized official
DR. NATHAN A GRADDY DDS (PRESIDENT DENTIST)
(813) 221-0010
Entity
Organization
Contact information
Practice address
2727 W DR MARTIN LUTHER KING JR BLVD STE 120, TAMPA, FL 33607-6353
(813) 873-9100
(813) 873-9176
Mailing address
2727 W DR MARTIN LUTHER KING JR BLVD STE 120, TAMPA, FL 33607-6353
(813) 873-9100
(813) 873-9176
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN4964
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
072704100
—
FL
Enumeration date
02/07/2007
Last updated
12/01/2011
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