Provider Demographics
NPI:1588245088
Name:FL PEDIATRIC PROFESSIONALS, P.A.
Entity type:Organization
Organization Name:FL PEDIATRIC PROFESSIONALS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRUGIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-378-1004
Mailing Address - Street 1:5710 N DAVIS HWY # 8
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2088
Mailing Address - Country:US
Mailing Address - Phone:850-378-1004
Mailing Address - Fax:
Practice Address - Street 1:10 RIVERWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-5017
Practice Address - Country:US
Practice Address - Phone:850-689-6766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty