Provider Demographics
NPI:1306397450
Name:SUMTER DENTAL CENTER, P.A.
Entity Type:Organization
Organization Name:SUMTER DENTAL CENTER, P.A.
Other - Org Name:SUMTER VALUE DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TEARSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-569-0100
Mailing Address - Street 1:410 E BELT AVE STE D
Mailing Address - Street 2:
Mailing Address - City:BUSHNELL
Mailing Address - State:FL
Mailing Address - Zip Code:33513-5208
Mailing Address - Country:US
Mailing Address - Phone:352-569-4962
Mailing Address - Fax:
Practice Address - Street 1:410 E BELT AVE STE D
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-5208
Practice Address - Country:US
Practice Address - Phone:352-569-4962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH B. NOVAK, DMD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty