Provider Demographics
NPI:1306459441
Name:CONTEMPORARY DENTAL PLLC
Entity type:Organization
Organization Name:CONTEMPORARY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-263-2980
Mailing Address - Street 1:5812 VALENTE PL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-1706
Mailing Address - Country:US
Mailing Address - Phone:941-302-7778
Mailing Address - Fax:
Practice Address - Street 1:5136 OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:SIESTA KEY
Practice Address - State:FL
Practice Address - Zip Code:34242-1637
Practice Address - Country:US
Practice Address - Phone:646-263-2980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental