Provider Demographics
NPI:1215105507
Name:SARASOTA DENTAL GROUP
Entity type:Organization
Organization Name:SARASOTA DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KARP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-926-0000
Mailing Address - Street 1:3333 CLARK RD STE 140
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8433
Mailing Address - Country:US
Mailing Address - Phone:941-926-0000
Mailing Address - Fax:941-922-7477
Practice Address - Street 1:3333 CLARK RD STE 140
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-8433
Practice Address - Country:US
Practice Address - Phone:941-926-0000
Practice Address - Fax:941-922-7477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15570122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty