Provider Demographics
NPI:1114902491
Name:APPLE DENTAL AFFILIATES, PA
Entity Type:Organization
Organization Name:APPLE DENTAL AFFILIATES, PA
Other - Org Name:APPLE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CDO/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:B
Authorized Official - Last Name:APPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-896-3368
Mailing Address - Street 1:125 5TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4168
Mailing Address - Country:US
Mailing Address - Phone:727-896-3368
Mailing Address - Fax:727-896-3368
Practice Address - Street 1:125 5TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4168
Practice Address - Country:US
Practice Address - Phone:727-896-3368
Practice Address - Fax:727-896-3368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty