Provider Demographics
NPI:1174282057
Name:FL DENTAL PROFESSIONALS, PA
Entity Type:Organization
Organization Name:FL DENTAL PROFESSIONALS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DENTAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRUGIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-620-5990
Mailing Address - Street 1:5300 MARYLAND WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5074
Mailing Address - Country:US
Mailing Address - Phone:615-620-5990
Mailing Address - Fax:
Practice Address - Street 1:5710 N DAVIS HWY STE 1
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2039
Practice Address - Country:US
Practice Address - Phone:850-391-3313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty