| Family Dental Group Inc | |
|
2727 W Dr Martin Luther King Jr Blvd Ste 120 Tampa FL 33607-6353 | |
| (813) 873-9100 | |
| (813) 873-9176 |
| Full Name | Family Dental Group Inc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2727 W Dr Martin Luther King Jr Blvd Ste 120, Tampa, Florida |
| Authorized Official Name and Position | Nathan A Graddy (PRESIDENT DENTIST) |
| Authorized Official Contact | 8132210010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Dental Group Inc 2727 W Dr Martin Luther King Jr Blvd Ste 120 Tampa FL 33607-6353 Ph: (813) 873-9100 | Family Dental Group Inc 2727 W Dr Martin Luther King Jr Blvd Ste 120 Tampa FL 33607-6353 Ph: (813) 873-9100 |
| NPI Number | 1790825289 |
|---|---|
| Provider Enumeration Date | 02/07/2007 |
| Last Update Date | 12/01/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790825289 | NPI | - | NPPES |
| 072704100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN4964 (Florida) | Primary |
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