Provider Demographics
NPI:1568890036
Name:NEW TAMPA DENTAL, P.A.
Entity Type:Organization
Organization Name:NEW TAMPA DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:Q
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-903-9877
Mailing Address - Street 1:18101 HIGHWOODS PRESERVE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1791
Mailing Address - Country:US
Mailing Address - Phone:813-903-9877
Mailing Address - Fax:813-903-9874
Practice Address - Street 1:18101 HIGHWOODS PRESERVE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1791
Practice Address - Country:US
Practice Address - Phone:813-903-9877
Practice Address - Fax:813-903-9874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13930122300000X
FLDN13967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty