Provider Demographics
NPI:1376910802
Name:SAFETY HARBOR DENTISTRY
Entity Type:Organization
Organization Name:SAFETY HARBOR DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRACI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-726-0865
Mailing Address - Street 1:353 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3646
Mailing Address - Country:US
Mailing Address - Phone:727-726-0865
Mailing Address - Fax:
Practice Address - Street 1:353 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3646
Practice Address - Country:US
Practice Address - Phone:727-726-0865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty