| Southshore Orthodontics Pa | |
|
13135 Kings Lake Dr # 103 Gibsonton FL 33534-3960 | |
| (813) 815-0080 | |
| Not Available |
| Full Name | Southshore Orthodontics Pa |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 13135 Kings Lake Dr # 103, Gibsonton, Florida |
| Authorized Official Name and Position | Matthew Ahrens (PRESIDENT) |
| Authorized Official Contact | 3528430783 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southshore Orthodontics Pa 13135 Kings Lake Dr # 103 Gibsonton FL 33534-3960 Ph: () - | Southshore Orthodontics Pa 13135 Kings Lake Dr # 103 Gibsonton FL 33534-3960 Ph: (813) 815-0080 |
| NPI Number | 1508255712 |
|---|---|
| Provider Enumeration Date | 01/12/2015 |
| Last Update Date | 01/13/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508255712 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 18985 (Florida) | Primary |
Kidzone Dentistry Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 13127 Kings Lake Dr Unit 101, Gibsonton, FL 33534 Phone: 813-677-3047 Fax: 813-284-7959 | |
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