Provider Demographics
NPI:1396433512
Name:PEDIATRIC DENTAL SPECIALISTS OF FLORIDA PLLC
Entity type:Organization
Organization Name:PEDIATRIC DENTAL SPECIALISTS OF FLORIDA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:928-941-2714
Mailing Address - Street 1:3983 DESTINATION DR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9510
Mailing Address - Country:US
Mailing Address - Phone:928-941-2714
Mailing Address - Fax:
Practice Address - Street 1:3983 DESTINATION DR UNIT 201
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9510
Practice Address - Country:US
Practice Address - Phone:928-941-2714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty