Provider Demographics
NPI:1689055238
Name:BRADENTON DENTAL CARE CORP
Entity Type:Organization
Organization Name:BRADENTON DENTAL CARE CORP
Other - Org Name:ONECO DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GANGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-751-4900
Mailing Address - Street 1:6320 15TH ST E
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-3250
Mailing Address - Country:US
Mailing Address - Phone:941-751-4900
Mailing Address - Fax:941-751-9090
Practice Address - Street 1:6320 15TH ST E
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-3250
Practice Address - Country:US
Practice Address - Phone:941-751-4900
Practice Address - Fax:941-751-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN3884122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty