Provider Demographics
NPI:1295206324
Name:DENTAL DAY LLC
Entity Type:Organization
Organization Name:DENTAL DAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHADAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAFSA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-775-8956
Mailing Address - Street 1:611 E BLOOMINGDALE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8127
Mailing Address - Country:US
Mailing Address - Phone:813-820-0071
Mailing Address - Fax:813-820-0072
Practice Address - Street 1:611 E BLOOMINGDALE AVE STE C
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8127
Practice Address - Country:US
Practice Address - Phone:813-820-0071
Practice Address - Fax:813-820-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty