Provider Demographics
NPI:1265867972
Name:TAMPASEDATION&FAMILYDENTISTRY
Entity type:Organization
Organization Name:TAMPASEDATION&FAMILYDENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANG
Authorized Official - Middle Name:V
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-498-1300
Mailing Address - Street 1:8416 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1606
Mailing Address - Country:US
Mailing Address - Phone:813-498-1300
Mailing Address - Fax:
Practice Address - Street 1:8416 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1606
Practice Address - Country:US
Practice Address - Phone:813-498-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17953122300000X
FLDN17217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty