Provider Demographics
NPI:1588822613
Name:THE DENTAL WALK IN CLINIC OF PINELLAS
Entity Type:Organization
Organization Name:THE DENTAL WALK IN CLINIC OF PINELLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-533-9199
Mailing Address - Street 1:1030 BELCHER RD S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3316
Mailing Address - Country:US
Mailing Address - Phone:727-533-9199
Mailing Address - Fax:727-533-9177
Practice Address - Street 1:1030 BELCHER RD S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3316
Practice Address - Country:US
Practice Address - Phone:727-533-9199
Practice Address - Fax:727-533-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty