Provider Demographics
NPI:1609241918
Name:LYSANDRO O. TAPNIO DMD PA
Entity type:Organization
Organization Name:LYSANDRO O. TAPNIO DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-641-0944
Mailing Address - Street 1:9272 ARLINGTON EXPY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-8212
Mailing Address - Country:US
Mailing Address - Phone:904-641-0944
Mailing Address - Fax:904-642-2999
Practice Address - Street 1:9272 ARLINGTON EXPY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-8212
Practice Address - Country:US
Practice Address - Phone:904-641-0944
Practice Address - Fax:904-642-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10175305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization