Provider Demographics
NPI:1609567056
Name:TAMPA BAY SMILES, INC.
Entity Type:Organization
Organization Name:TAMPA BAY SMILES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-857-8696
Mailing Address - Street 1:1307 MERRY WATER DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4810
Mailing Address - Country:US
Mailing Address - Phone:813-857-8696
Mailing Address - Fax:813-929-0996
Practice Address - Street 1:5438 LAND O LAKES BLVD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-3413
Practice Address - Country:US
Practice Address - Phone:813-929-0996
Practice Address - Fax:813-929-0996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty