Provider Demographics
NPI:1700030681
Name:FLORIDA DENTAL PRACTICES, LLC
Entity Type:Organization
Organization Name:FLORIDA DENTAL PRACTICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-221-2273
Mailing Address - Street 1:19007 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2475
Mailing Address - Country:US
Mailing Address - Phone:813-221-2273
Mailing Address - Fax:
Practice Address - Street 1:19007 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2475
Practice Address - Country:US
Practice Address - Phone:813-221-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN146941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty