Provider Demographics
NPI:1104686823
Name:FLORIDA HEALTH DENTAL, LLC
Entity type:Organization
Organization Name:FLORIDA HEALTH DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-300-4501
Mailing Address - Street 1:2664 TAMIAMI TRL E
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-5707
Mailing Address - Country:US
Mailing Address - Phone:239-428-1010
Mailing Address - Fax:239-785-1752
Practice Address - Street 1:2664 TAMIAMI TRL E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-5707
Practice Address - Country:US
Practice Address - Phone:239-428-1010
Practice Address - Fax:239-785-1752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty