Provider Demographics
NPI:1700183431
Name:PARADISE DENTAL
Entity Type:Organization
Organization Name:PARADISE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-627-5858
Mailing Address - Street 1:17840 TOLEDO BLADE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1015
Mailing Address - Country:US
Mailing Address - Phone:941-627-5858
Mailing Address - Fax:941-627-1863
Practice Address - Street 1:17840 TOLEDO BLADE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1015
Practice Address - Country:US
Practice Address - Phone:941-627-5858
Practice Address - Fax:941-627-1863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty