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2001 W Busch Blvd Suite C Tampa FL 33612-7517 | |
| (813) 932-3940 | |
| (813) 933-6277 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 2001 W Busch Blvd, Tampa, Florida |
| Authorized Official Name and Position | Richard Michael Kernagis (PRESIDENT) |
| Authorized Official Contact | 8139323940 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2001 W Busch Blvd Suite C Tampa FL 33612-7517 Ph: (813) 932-3940 | 2001 W Busch Blvd Suite C Tampa FL 33612-7517 Ph: (813) 932-3940 |
| NPI Number | 1760693857 |
|---|---|
| Provider Enumeration Date | 05/24/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760693857 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 15256 (Florida) | Secondary |
| 122300000X | Dentist | 15191 (Florida) | Primary |
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