Provider Demographics
NPI:1891308557
Name:SEMINOLE HARP PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:SEMINOLE HARP PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIRLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALIX MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:EFDA
Authorized Official - Phone:813-952-6546
Mailing Address - Street 1:31067 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-4416
Mailing Address - Country:US
Mailing Address - Phone:727-304-5483
Mailing Address - Fax:727-260-4098
Practice Address - Street 1:8686 131ST ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-2700
Practice Address - Country:US
Practice Address - Phone:727-304-5483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEMINOLE HARP PEDIATRIC DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty