Provider Demographics
NPI:1942378054
Name:TMJ & FACIAL PAIN CENTER
Entity Type:Organization
Organization Name:TMJ & FACIAL PAIN CENTER
Other - Org Name:ARBOR DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-327-0000
Mailing Address - Street 1:5454 CENTRAL AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707
Mailing Address - Country:US
Mailing Address - Phone:727-327-0000
Mailing Address - Fax:727-328-1782
Practice Address - Street 1:5454 CENTRAL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707
Practice Address - Country:US
Practice Address - Phone:727-327-0000
Practice Address - Fax:727-328-1782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4273122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty