Provider Demographics
NPI:1487067344
Name:DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA, PA
Entity type:Organization
Organization Name:DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LESSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-571-3471
Mailing Address - Street 1:136 4TH ST N STE 201
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3889
Mailing Address - Country:US
Mailing Address - Phone:727-800-8026
Mailing Address - Fax:727-304-3164
Practice Address - Street 1:3731 NW 40TH TER STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-8148
Practice Address - Country:US
Practice Address - Phone:352-376-6366
Practice Address - Fax:352-376-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN122411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty