Provider Demographics
NPI:1366890501
Name:SAFETY HARBOR FAMILY DENTISTRY PA
Entity type:Organization
Organization Name:SAFETY HARBOR FAMILY DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUIFANG
Authorized Official - Middle Name:
Authorized Official - Last Name:CAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-975-1560
Mailing Address - Street 1:353 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3646
Mailing Address - Country:US
Mailing Address - Phone:781-975-1560
Mailing Address - Fax:
Practice Address - Street 1:353 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3646
Practice Address - Country:US
Practice Address - Phone:781-975-1560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN212301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1578943353OtherINDIVIDUAL NPI
FLDN21230OtherDENTAL LICENSENUMBER