Provider Demographics
NPI:1043354574
Name:PRESTIGE DENTAL
Entity Type:Organization
Organization Name:PRESTIGE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DATA INPUT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARGARETHA
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-918-1416
Mailing Address - Street 1:8408 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-2936
Mailing Address - Country:US
Mailing Address - Phone:941-918-1416
Mailing Address - Fax:941-918-9726
Practice Address - Street 1:8408 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-2936
Practice Address - Country:US
Practice Address - Phone:941-918-1416
Practice Address - Fax:941-918-9726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN162071223G0001X
FLDN131891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty