Provider Demographics
NPI:1699927525
Name:FLORIDA EMERGENCY DENTAL CARE, LLC
Entity type:Organization
Organization Name:FLORIDA EMERGENCY DENTAL CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:THOMASINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-743-6824
Mailing Address - Street 1:1825 TAMIAMI TRL
Mailing Address - Street 2:UNIT #A-4
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1077
Mailing Address - Country:US
Mailing Address - Phone:941-743-6824
Mailing Address - Fax:941-743-6820
Practice Address - Street 1:1825 TAMIAMI TRL
Practice Address - Street 2:UNIT #A-4
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1077
Practice Address - Country:US
Practice Address - Phone:941-743-6824
Practice Address - Fax:941-743-6820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty