Provider Demographics
NPI:1023568854
Name:DENTAL ASSOCIATES OF FLORIDA (SUN CITY CENTER) PLLC
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF FLORIDA (SUN CITY CENTER) PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP INSURANCE PLAN MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-955-3150
Mailing Address - Street 1:4040 UPPER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6844
Mailing Address - Country:US
Mailing Address - Phone:813-633-3339
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty