Organization
FLORIDA DENTAL PROFESSIONALS, P.A.
Active
Parent organization
FLORIDA DENTAL PROFESSIONALS, P.A.
Other names
Esthetic & Integrative Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
FLORIDA DENTAL PROFESSIONALS, P.A.
Authorized official
TABATHA LEMKE (CREDENTIALING COORDINATOR)
(217) 540-6078
Entity
Organization
Contact information
Practice address
390 4TH ST N STE 101, ST PETERSBURG, FL 33701-2802
(737) 282-1980
Mailing address
390 4TH ST N STE 101, ST PETERSBURG, FL 33701-2802
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/25/2019
Last updated
11/09/2020
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