Provider Demographics
NPI:1932468675
Name:DE LUCIA FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:DE LUCIA FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PING PING
Authorized Official - Middle Name:H
Authorized Official - Last Name:DE LUCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,
Authorized Official - Phone:727-215-3963
Mailing Address - Street 1:6700 CROSSWINDS DR N
Mailing Address - Street 2:SUITE 300 C
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8602
Mailing Address - Country:US
Mailing Address - Phone:727-341-2422
Mailing Address - Fax:
Practice Address - Street 1:6700 CROSSWINDS DR N
Practice Address - Street 2:SUITE 300 C
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8602
Practice Address - Country:US
Practice Address - Phone:727-341-2422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18757305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization