Provider Demographics
NPI:1609181692
Name:FROUG ELLENTON DENTAL CENTER
Entity Type:Organization
Organization Name:FROUG ELLENTON DENTAL CENTER
Other - Org Name:PINEBROOK DENTAL NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-795-0877
Mailing Address - Street 1:6222 US HIGHWAY 301 N
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-3065
Mailing Address - Country:US
Mailing Address - Phone:941-729-6636
Mailing Address - Fax:
Practice Address - Street 1:6222 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-3065
Practice Address - Country:US
Practice Address - Phone:941-729-6636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10494122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty