Provider Demographics
NPI:1639653611
Name:TAMPA DENTAL WELLNESS OF WESTCHASE
Entity Type:Organization
Organization Name:TAMPA DENTAL WELLNESS OF WESTCHASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CREECH-GIONIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-855-2273
Mailing Address - Street 1:11321 COUNTRYWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2610
Mailing Address - Country:US
Mailing Address - Phone:813-855-2273
Mailing Address - Fax:813-749-7980
Practice Address - Street 1:11321 COUNTRYWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2610
Practice Address - Country:US
Practice Address - Phone:813-855-2273
Practice Address - Fax:813-749-7980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental