Provider Demographics
NPI:1497106033
Name:AFFILIATED DENTAL SPECIALIST
Entity Type:Organization
Organization Name:AFFILIATED DENTAL SPECIALIST
Other - Org Name:DENTAL SPECIALISTS OF FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOOPAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-337-6746
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:727-474-0317
Mailing Address - Fax:727-526-1702
Practice Address - Street 1:2488 W BRANDON BLVD STE B
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4710
Practice Address - Country:US
Practice Address - Phone:813-337-6746
Practice Address - Fax:813-661-6240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN93191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty