| Tarpon Shores Dental, Llc | |
|
544 John Ringling Blvd Sarasota FL 34236-1430 | |
| (941) 388-4114 | |
| Not Available |
| Full Name | Tarpon Shores Dental, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 544 John Ringling Blvd, Sarasota, Florida |
| Authorized Official Name and Position | Chandeev Romesh Weerasooriya (MANAGER) |
| Authorized Official Contact | 9414749548 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tarpon Shores Dental, Llc 1314 E Venice Ave Suite F Venice FL 34285-7160 Ph: (941) 488-7910 | Tarpon Shores Dental, Llc 544 John Ringling Blvd Sarasota FL 34236-1430 Ph: (941) 388-4114 |
| NPI Number | 1447597802 |
|---|---|
| Provider Enumeration Date | 01/05/2013 |
| Last Update Date | 11/22/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447597802 | NPI | - | NPPES |
| 511613837863 | Other | FL | MEDICARE CCN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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