Provider Demographics
NPI:1023389699
Name:DENTAL ASSOCIATES OF SUNCITY
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF SUNCITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DELAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-633-3339
Mailing Address - Street 1:4040 UPPER CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:SUNCITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573
Mailing Address - Country:US
Mailing Address - Phone:813-633-3339
Mailing Address - Fax:813-633-3313
Practice Address - Street 1:4040 UPPER CREEK DR
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6844
Practice Address - Country:US
Practice Address - Phone:813-633-3339
Practice Address - Fax:813-633-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN193121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty