Provider Demographics
NPI:1760997175
Name:ALAN D. SHOOPAK, D.M.D., P.A.
Entity Type:Organization
Organization Name:ALAN D. SHOOPAK, D.M.D., P.A.
Other - Org Name:ORTHODONTIC SPECIALISTS OF FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHOOPAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-522-5599
Mailing Address - Street 1:6311 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-7511
Mailing Address - Country:US
Mailing Address - Phone:727-522-5599
Mailing Address - Fax:
Practice Address - Street 1:1626 RINGLING BLVD STE 500
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-6830
Practice Address - Country:US
Practice Address - Phone:727-522-5599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN93191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty