Provider Demographics
NPI:1831258847
Name:WESTCHASE DENTAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:WESTCHASE DENTAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-818-0600
Mailing Address - Street 1:11369 COUNTRYWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2610
Mailing Address - Country:US
Mailing Address - Phone:813-818-0600
Mailing Address - Fax:813-818-8405
Practice Address - Street 1:11369 COUNTRYWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2610
Practice Address - Country:US
Practice Address - Phone:813-818-0600
Practice Address - Fax:813-818-8405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0141901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64906OtherBCBS
FL871628OtherUNITED CONCORDIA