Provider Demographics
NPI:1861635864
Name:PINELLAS DENTAL ARTS
Entity Type:Organization
Organization Name:PINELLAS DENTAL ARTS
Other - Org Name:SOLDATOS DENTAL ARTS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTATINOS
Authorized Official - Middle Name:NICHOLA
Authorized Official - Last Name:SOLDATOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-442-3363
Mailing Address - Street 1:706 S FORT HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5304
Mailing Address - Country:US
Mailing Address - Phone:727-442-3363
Mailing Address - Fax:
Practice Address - Street 1:706 S FORT HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5304
Practice Address - Country:US
Practice Address - Phone:727-442-3363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINELLAS DENTAL ARTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL133141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty