Provider Demographics
NPI:1821492703
Name:GENERAL AND IMPLANT DENTISTRY OF TAMPA BAY, LLC
Entity Type:Organization
Organization Name:GENERAL AND IMPLANT DENTISTRY OF TAMPA BAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MURAD
Authorized Official - Middle Name:
Authorized Official - Last Name:RASHID
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-531-9363
Mailing Address - Street 1:14010 ROOSEVELT BLVD
Mailing Address - Street 2:STE 704
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-3862
Mailing Address - Country:US
Mailing Address - Phone:727-531-9363
Mailing Address - Fax:
Practice Address - Street 1:14010 ROOSEVELT BLVD
Practice Address - Street 2:STE 704
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3862
Practice Address - Country:US
Practice Address - Phone:727-531-9363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17945122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty