Provider Demographics
NPI:1992364327
Name:MUSCARO AND MARTINI DENTISTRY
Entity type:Organization
Organization Name:MUSCARO AND MARTINI DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-831-6999
Mailing Address - Street 1:3502 W BAY TO BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7045
Mailing Address - Country:US
Mailing Address - Phone:813-839-6999
Mailing Address - Fax:
Practice Address - Street 1:3502 W BAY TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7045
Practice Address - Country:US
Practice Address - Phone:813-839-6999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUSCARO AND MARTINI DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies