Provider Demographics
NPI:1710099353
Name:AESTHETIC DENTISTRY OF NEW TAMPA
Entity Type:Organization
Organization Name:AESTHETIC DENTISTRY OF NEW TAMPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-991-1088
Mailing Address - Street 1:8709 HUNTERS GREEN DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2309
Mailing Address - Country:US
Mailing Address - Phone:813-991-1088
Mailing Address - Fax:813-991-4817
Practice Address - Street 1:8709 HUNTERS GREEN DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2309
Practice Address - Country:US
Practice Address - Phone:813-991-1088
Practice Address - Fax:813-991-4817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN146941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty