Provider Demographics
NPI:1295971463
Name:TAMPA BAY DENTAL IMPLANTS & PERIODONTICS, PL
Entity type:Organization
Organization Name:TAMPA BAY DENTAL IMPLANTS & PERIODONTICS, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-384-9122
Mailing Address - Street 1:6700 CROSSWINDS DR N
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8602
Mailing Address - Country:US
Mailing Address - Phone:727-384-9122
Mailing Address - Fax:
Practice Address - Street 1:6700 CROSSWINDS DR N
Practice Address - Street 2:SUITE 200B
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8602
Practice Address - Country:US
Practice Address - Phone:727-384-9122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17038261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental