Provider Demographics
NPI:1467894980
Name:PEDIATRIC DENTISTRY OF BRANDON PA
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY OF BRANDON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-398-7143
Mailing Address - Street 1:517 CORNER DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5718
Mailing Address - Country:US
Mailing Address - Phone:787-398-7143
Mailing Address - Fax:813-681-7213
Practice Address - Street 1:517 CORNER DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5718
Practice Address - Country:US
Practice Address - Phone:787-398-7143
Practice Address - Fax:813-681-7213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty