Provider Demographics
NPI:1952633265
Name:GULFSHORE DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:GULFSHORE DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRAV
Authorized Official - Middle Name:AMRIT
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:863-675-3270
Mailing Address - Street 1:813 E HICKPOCHEE AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-5033
Mailing Address - Country:US
Mailing Address - Phone:863-675-3270
Mailing Address - Fax:863-675-3868
Practice Address - Street 1:813 E HICKPOCHEE AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-5033
Practice Address - Country:US
Practice Address - Phone:863-675-3270
Practice Address - Fax:863-675-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL157231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty