Provider Demographics
NPI:1023262979
Name:FAMILY DENTAL CARE CLINIC
Entity type:Organization
Organization Name:FAMILY DENTAL CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEKSANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:PRECAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-441-1571
Mailing Address - Street 1:1200 S HIGHLAND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4334
Mailing Address - Country:US
Mailing Address - Phone:727-441-1571
Mailing Address - Fax:
Practice Address - Street 1:1200 S HIGHLAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4334
Practice Address - Country:US
Practice Address - Phone:727-441-1571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN184771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty