Provider Demographics
NPI:1891268413
Name:DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA PA
Entity Type:Organization
Organization Name:DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA PA
Other - Org Name:DENTAL PARTNERS - MELBOURNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NATIONAL DIRECTOR OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LESSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-571-3471
Mailing Address - Street 1:9400 4TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2501
Mailing Address - Country:US
Mailing Address - Phone:727-800-8026
Mailing Address - Fax:727-339-6543
Practice Address - Street 1:2419 S BABCOCK ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5310
Practice Address - Country:US
Practice Address - Phone:321-956-7700
Practice Address - Fax:321-956-8479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty