Provider Demographics
NPI:1881261659
Name:JACOB PEDRAZA DMD PA
Entity type:Organization
Organization Name:JACOB PEDRAZA DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDRAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-741-0186
Mailing Address - Street 1:2638 NARNIA WAY UNIT 102
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7321
Mailing Address - Country:US
Mailing Address - Phone:813-949-2229
Mailing Address - Fax:
Practice Address - Street 1:2638 NARNIA WAY UNIT 102
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7321
Practice Address - Country:US
Practice Address - Phone:813-949-2229
Practice Address - Fax:813-949-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental