Provider Demographics
NPI:1821740283
Name:SEMINOLE HEIGHTS FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:SEMINOLE HEIGHTS FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KALI
Authorized Official - Middle Name:R
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-882-5211
Mailing Address - Street 1:4413 W BEACH PARK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3701
Mailing Address - Country:US
Mailing Address - Phone:724-699-3679
Mailing Address - Fax:
Practice Address - Street 1:300 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-6929
Practice Address - Country:US
Practice Address - Phone:813-882-5211
Practice Address - Fax:813-435-9225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental