Provider Demographics
NPI:1518576727
Name:CITI DENTAL OF TAMPA, LLC
Entity Type:Organization
Organization Name:CITI DENTAL OF TAMPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:BATTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-423-1452
Mailing Address - Street 1:9309 N FLORIDA AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7237
Mailing Address - Country:US
Mailing Address - Phone:813-331-4578
Mailing Address - Fax:
Practice Address - Street 1:9309 N FLORIDA AVE STE 111
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7237
Practice Address - Country:US
Practice Address - Phone:813-331-4578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100902000Medicaid