Provider Demographics
NPI:1215014337
Name:GOLDEN DENTAL EXCELLENCE
Entity Type:Organization
Organization Name:GOLDEN DENTAL EXCELLENCE
Other - Org Name:PRESTIGE DENTISTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-376-3763
Mailing Address - Street 1:7280 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653
Mailing Address - Country:US
Mailing Address - Phone:727-376-3763
Mailing Address - Fax:727-376-4073
Practice Address - Street 1:7280 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653
Practice Address - Country:US
Practice Address - Phone:727-376-3763
Practice Address - Fax:727-376-4073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID #