Provider Demographics
NPI:1508943796
Name:THURSTON & ACOSTA DENTAL ASSOCIATES,PL
Entity Type:Organization
Organization Name:THURSTON & ACOSTA DENTAL ASSOCIATES,PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:THURSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:863-967-7548
Mailing Address - Street 1:308 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-3411
Mailing Address - Country:US
Mailing Address - Phone:863-967-7548
Mailing Address - Fax:863-967-7693
Practice Address - Street 1:308 E PARK ST
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-3411
Practice Address - Country:US
Practice Address - Phone:863-967-7548
Practice Address - Fax:863-967-7693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL84131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty