Provider Demographics
NPI:1982897633
Name:DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES
Other - Org Name:SUNCOAST DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:KEHM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:727-321-4850
Mailing Address - Street 1:4850 1ST AV N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8108
Mailing Address - Country:US
Mailing Address - Phone:727-321-4850
Mailing Address - Fax:727-323-1679
Practice Address - Street 1:4850 1ST AV N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8108
Practice Address - Country:US
Practice Address - Phone:727-321-4850
Practice Address - Fax:727-323-1679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL5865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty