Provider Demographics
NPI:1457781361
Name:DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA, PA
Entity Type:Organization
Organization Name:DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA, PA
Other - Org Name:WATERSIDE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NATIONAL DIRECTOR OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LESSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-571-3471
Mailing Address - Street 1:136 4TH ST N STE 201
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3889
Mailing Address - Country:US
Mailing Address - Phone:727-800-8026
Mailing Address - Fax:727-304-3164
Practice Address - Street 1:1058 N TAMIAMI TRL STE 106
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-2427
Practice Address - Country:US
Practice Address - Phone:941-870-3322
Practice Address - Fax:941-953-5959
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-14
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN115951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty