| |
6112 Parkset Dr Lithia FL 33547-4872 | |
(813) 940-2313 | |
Not Available |
Full Name | |
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Speciality | Dental Hygienist |
Location | 6112 Parkset Dr, Lithia, Florida |
Authorized Official Name and Position | Mauricio Orlandi (OWNER) |
Authorized Official Contact | 7274245202 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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6112 Parkset Dr Lithia FL 33547-4872 Ph: (813) 940-2313 | 6112 Parkset Dr Lithia FL 33547-4872 Ph: (813) 940-2313 |
NPI Number | 1831973379 |
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Provider Enumeration Date | 08/24/2023 |
Last Update Date | 12/26/2023 |
Medicare PECOS PAC ID | 4183067424 |
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Medicare Enrollment ID | O20240203000348 |
Identifier | Type | State | Issuer |
---|---|---|---|
1831973379 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
124Q00000X | Dental Hygienist | (* (Not Available)) | Primary |
Provider Name | Felipe Salles |
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Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1003330416 PECOS PAC ID: 8628411964 Enrollment ID: I20240203000384 |
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