Provider Demographics
NPI:1508140138
Name:DAVID J BUSCIGLIO DMD PA
Entity Type:Organization
Organization Name:DAVID J BUSCIGLIO DMD PA
Other - Org Name:BAY AREA TMJ & SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSCIGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-685-6200
Mailing Address - Street 1:611 LUMSDEN PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5996
Mailing Address - Country:US
Mailing Address - Phone:813-685-6200
Mailing Address - Fax:813-200-3910
Practice Address - Street 1:611 LUMSDEN PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5996
Practice Address - Country:US
Practice Address - Phone:813-685-6200
Practice Address - Fax:813-200-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13764122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6580880001Medicare NSC