Provider Demographics
NPI:1831433994
Name:PEDRO A. BELAUNZARAN DDS PA
Entity type:Organization
Organization Name:PEDRO A. BELAUNZARAN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENSTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:ANIBAL
Authorized Official - Last Name:BELAUNZARAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-243-4142
Mailing Address - Street 1:8130 W WATERS AVE
Mailing Address - Street 2:SUITE 200-B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1821
Mailing Address - Country:US
Mailing Address - Phone:813-243-4142
Mailing Address - Fax:
Practice Address - Street 1:8130 W WATERS AVE
Practice Address - Street 2:SUITE 200-B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1821
Practice Address - Country:US
Practice Address - Phone:813-243-4142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL074916800Medicaid