Provider Demographics
NPI:1033664651
Name:PROSTHODONTICS & IMPLANT THERAPY INC
Entity Type:Organization
Organization Name:PROSTHODONTICS & IMPLANT THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:M REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:IRANMANESH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-933-6705
Mailing Address - Street 1:2814 W WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1853
Mailing Address - Country:US
Mailing Address - Phone:813-933-6705
Mailing Address - Fax:
Practice Address - Street 1:2814 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1853
Practice Address - Country:US
Practice Address - Phone:813-933-6705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty