Provider Demographics
NPI:1609987817
Name:JENNIFER ROCO PAULMINO DDS PROF DENTAL PA
Entity Type:Organization
Organization Name:JENNIFER ROCO PAULMINO DDS PROF DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ROCO
Authorized Official - Last Name:PAULMINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-320-8831
Mailing Address - Street 1:10333 SEMINOLE BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778
Mailing Address - Country:US
Mailing Address - Phone:727-320-8831
Mailing Address - Fax:727-320-8832
Practice Address - Street 1:10333 SEMINOLE BLVD STE 7
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778
Practice Address - Country:US
Practice Address - Phone:727-320-8831
Practice Address - Fax:727-320-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty