Provider Demographics
NPI:1285247718
Name:T & C DENTAL OF PALM HARBOR P. CORP
Entity type:Organization
Organization Name:T & C DENTAL OF PALM HARBOR P. CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THAI
Authorized Official - Middle Name:
Authorized Official - Last Name:HUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-772-1710
Mailing Address - Street 1:33633 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-2639
Mailing Address - Country:US
Mailing Address - Phone:727-772-1710
Mailing Address - Fax:
Practice Address - Street 1:33633 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2639
Practice Address - Country:US
Practice Address - Phone:727-772-1710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental