Provider Demographics
NPI:1770120180
Name:MAI FAMILY AND SEDATION DENTISTRY, PA
Entity type:Organization
Organization Name:MAI FAMILY AND SEDATION DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THANH
Authorized Official - Middle Name:T
Authorized Official - Last Name:MAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-800-0022
Mailing Address - Street 1:495 31ST STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713
Mailing Address - Country:US
Mailing Address - Phone:727-800-0022
Mailing Address - Fax:727-295-2602
Practice Address - Street 1:495 31ST STREET NORTH
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713
Practice Address - Country:US
Practice Address - Phone:727-800-0022
Practice Address - Fax:727-295-2602
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAI FAMILY AND SEDATION DENTISTRY, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty