Provider Demographics
NPI:1891465779
Name:DENTISTRY OF NORTH PORT PA
Entity Type:Organization
Organization Name:DENTISTRY OF NORTH PORT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:754-610-9880
Mailing Address - Street 1:13801 TAMIAMI TRL STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2017
Mailing Address - Country:US
Mailing Address - Phone:941-200-5812
Mailing Address - Fax:
Practice Address - Street 1:13801 TAMIAMI TRL STE B
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2017
Practice Address - Country:US
Practice Address - Phone:941-200-5812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental