Provider Demographics
NPI:1447327010
Name:DENTAL SPECIALTY GROUP OF PINELLAS
Entity type:Organization
Organization Name:DENTAL SPECIALTY GROUP OF PINELLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DURBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-544-5345
Mailing Address - Street 1:4326 PARK BLVD
Mailing Address - Street 2:C EAST
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3555
Mailing Address - Country:US
Mailing Address - Phone:727-544-5345
Mailing Address - Fax:727-547-8263
Practice Address - Street 1:4326 PARK BLVD
Practice Address - Street 2:C EAST
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3555
Practice Address - Country:US
Practice Address - Phone:727-544-5345
Practice Address - Fax:727-547-8263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN5630122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty