Provider Demographics
NPI:1083912539
Name:GURLEY DENTAL GROUP PL
Entity Type:Organization
Organization Name:GURLEY DENTAL GROUP PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RENDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-935-9414
Mailing Address - Street 1:12425 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4201
Mailing Address - Country:US
Mailing Address - Phone:813-935-5631
Mailing Address - Fax:813-935-5631
Practice Address - Street 1:12425 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4201
Practice Address - Country:US
Practice Address - Phone:813-935-9414
Practice Address - Fax:813-935-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN108261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty