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4340 W Hillsborough Ave Ste 702 Tampa FL 33614-5560 | |
| (954) 562-2844 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4340 W Hillsborough Ave Ste 702, Tampa, Florida |
| Authorized Official Name and Position | Keith C Simon (OWNER/GENERAL DENTIST) |
| Authorized Official Contact | 9545622844 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4340 W Hillsborough Ave Ste 702 Tampa FL 33614-5560 Ph: (954) 562-2844 | 4340 W Hillsborough Ave Ste 702 Tampa FL 33614-5560 Ph: (954) 562-2844 |
| NPI Number | 1841855566 |
|---|---|
| Provider Enumeration Date | 05/08/2019 |
| Last Update Date | 08/11/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841855566 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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