Provider Demographics
NPI:1154762177
Name:PARADIGM DENTAL
Entity type:Organization
Organization Name:PARADIGM DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUAYB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-678-0418
Mailing Address - Street 1:12900 CORTEZ BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613
Mailing Address - Country:US
Mailing Address - Phone:352-596-3456
Mailing Address - Fax:352-596-3147
Practice Address - Street 1:12900 CORTEZ BLVD
Practice Address - Street 2:STE 201
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613
Practice Address - Country:US
Practice Address - Phone:352-596-3456
Practice Address - Fax:352-596-3147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN173881223G0001X
FLDN177341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty