Provider Demographics
NPI:1477664266
Name:FLORIDA DENTAL CENTERS
Entity Type:Organization
Organization Name:FLORIDA DENTAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-461-9149
Mailing Address - Street 1:2189 CLEVELAND ST
Mailing Address - Street 2:SUITE 252
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765
Mailing Address - Country:US
Mailing Address - Phone:727-461-9149
Mailing Address - Fax:727-446-8382
Practice Address - Street 1:2189 CLEVELAND ST
Practice Address - Street 2:SUITE 252
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765
Practice Address - Country:US
Practice Address - Phone:727-461-9149
Practice Address - Fax:727-446-8382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X, 1223P0300X, 1223S0112X
FLDN136801223S0112X, 1223S0112X
FLND00123181223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty