Provider Demographics
NPI:1720192909
Name:FLORIDA SPECIAL CARE DENTISTRY
Entity Type:Organization
Organization Name:FLORIDA SPECIAL CARE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIS
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANDEW
Authorized Official - Last Name:POWLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-251-2314
Mailing Address - Street 1:1 DAVIS BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3463
Mailing Address - Country:US
Mailing Address - Phone:813-251-2314
Mailing Address - Fax:813-254-6166
Practice Address - Street 1:1 DAVIS BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3463
Practice Address - Country:US
Practice Address - Phone:813-251-2314
Practice Address - Fax:813-254-6166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental