Provider Demographics
NPI:1619376746
Name:VESPA FAMILY DENTAL PA
Entity Type:Organization
Organization Name:VESPA FAMILY DENTAL PA
Other - Org Name:PINELLAS FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:VESPA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-518-8349
Mailing Address - Street 1:120 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3602
Mailing Address - Country:US
Mailing Address - Phone:727-518-8349
Mailing Address - Fax:727-518-8339
Practice Address - Street 1:120 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3602
Practice Address - Country:US
Practice Address - Phone:727-518-8349
Practice Address - Fax:727-518-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 131941223G0001X
FLDN 188891223G0001X
FLDN 129191223G0001X
FLDN 129531223G0001X
FLDN 62951223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty