Provider Demographics
NPI:1932268125
Name:BEATRIZ TOTZKE DDS PA
Entity Type:Organization
Organization Name:BEATRIZ TOTZKE DDS PA
Other - Org Name:ALL AGES DENTAL SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:BEATRIZ
Authorized Official - Last Name:RIBEIRO-TOTZKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-814-4000
Mailing Address - Street 1:11333 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:813-814-4000
Mailing Address - Fax:813-814-9933
Practice Address - Street 1:11333 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:813-814-4000
Practice Address - Fax:813-814-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 15588122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID