Provider Demographics
NPI:1851689392
Name:APOLLO BEACH DENTAL, PL
Entity type:Organization
Organization Name:APOLLO BEACH DENTAL, PL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-645-1501
Mailing Address - Street 1:101 FLAMINGO DR STE D
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2600
Mailing Address - Country:US
Mailing Address - Phone:813-645-1501
Mailing Address - Fax:813-645-3753
Practice Address - Street 1:101 FLAMINGO DR STE D
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2600
Practice Address - Country:US
Practice Address - Phone:813-645-1501
Practice Address - Fax:813-645-3753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17038261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental