Provider Demographics
NPI:1992194161
Name:TAMPA DENTAL
Entity Type:Organization
Organization Name:TAMPA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVOUKLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-888-9004
Mailing Address - Street 1:6421 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3102
Mailing Address - Country:US
Mailing Address - Phone:813-888-9004
Mailing Address - Fax:813-888-9517
Practice Address - Street 1:6421 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3102
Practice Address - Country:US
Practice Address - Phone:813-888-9004
Practice Address - Fax:813-888-9517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty