Provider Demographics
NPI:1720408917
Name:DENTISTRY OF SARASOTA LLC
Entity Type:Organization
Organization Name:DENTISTRY OF SARASOTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-921-7055
Mailing Address - Street 1:3990 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2363
Mailing Address - Country:US
Mailing Address - Phone:941-921-7055
Mailing Address - Fax:941-923-0764
Practice Address - Street 1:3990 CLARK RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2363
Practice Address - Country:US
Practice Address - Phone:941-921-7055
Practice Address - Fax:941-923-0764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-26
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16194122300000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7129750001Medicare NSC