PEDIATRIC DENTAL CENTER NPI 1710244702

NPI Information

NPI: 1710244702
Provider Name: PEDIATRIC DENTAL CENTER
Classification: Dentist - 1223P0221X
Entity Type: Organization

Specialization: Pediatric Dentistry

Address:
517 CORNER DRIVE
BRANDON, FL
ZIP 33511
Phone: (813) 685-0804
Get Directions

PEDIATRIC DENTAL CENTER is a pediatric dentistry dentist in Brandon, FL. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. PEDIATRIC DENTAL CENTER NPI is 1710244702. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

517 CORNER DRIVE
BRANDON, FL
ZIP 33511-718
Phone: (813) 685-0804
Fax: (813) 681-7213

The provider's authorized official is William Edward Gonzalez .
The authorized official title is President and has the following contact phone number (813) 685-0804.

The enumeration date for this NPI number is 4/16/2012 and was last updated on 4/16/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223P0221X	Dentist	Pediatric Dentistry	DN6377	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	074133700	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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