Provider Demographics
NPI:1417082405
Name:ALAN D SHOOPAK DMD ORTHODONTIC GROUP IV LLC
Entity Type:Organization
Organization Name:ALAN D SHOOPAK DMD ORTHODONTIC GROUP IV LLC
Other - Org Name:ORTHODONTIC SPECIALISTS OF FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHOOPAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-522-5599
Mailing Address - Street 1:6311 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-7511
Mailing Address - Country:US
Mailing Address - Phone:727-522-5599
Mailing Address - Fax:727-526-1702
Practice Address - Street 1:1956 41ST AVE
Practice Address - Street 2:STE A
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0575
Practice Address - Country:US
Practice Address - Phone:772-562-2439
Practice Address - Fax:772-562-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty