Provider Demographics
NPI:1073054789
Name:ALL CHILDREN'S PEDIATRIC DENTISTRY LLC
Entity Type:Organization
Organization Name:ALL CHILDREN'S PEDIATRIC DENTISTRY LLC
Other - Org Name:YARBROUGH ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:YARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-385-2844
Mailing Address - Street 1:16688 N DALE MABRY HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1400
Mailing Address - Country:US
Mailing Address - Phone:813-374-9695
Mailing Address - Fax:813-333-7323
Practice Address - Street 1:16688 N DALE MABRY HWY
Practice Address - Street 2:SUITE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1400
Practice Address - Country:US
Practice Address - Phone:813-374-9695
Practice Address - Fax:813-333-7323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN187941223P0221X
1223P0221X
FLDN184451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty