Provider Demographics
NPI:1659704203
Name:LEMON BAY DENTAL CARE PA
Entity Type:Organization
Organization Name:LEMON BAY DENTAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTINEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-474-2664
Mailing Address - Street 1:1505 S MCCALL RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-4876
Mailing Address - Country:US
Mailing Address - Phone:941-474-2664
Mailing Address - Fax:941-475-5920
Practice Address - Street 1:1505 S MCCALL RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4876
Practice Address - Country:US
Practice Address - Phone:941-474-2664
Practice Address - Fax:941-475-5920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty