Provider Demographics
NPI:1497132559
Name:ADVANCED DENTAL CARE SPECIALISTS INC
Entity Type:Organization
Organization Name:ADVANCED DENTAL CARE SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-869-3886
Mailing Address - Street 1:13736 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-8024
Mailing Address - Country:US
Mailing Address - Phone:727-869-3886
Mailing Address - Fax:
Practice Address - Street 1:13736 LITTLE RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-8024
Practice Address - Country:US
Practice Address - Phone:727-869-3886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty