Dental Assoc of South Brandon

NPI #1588088223 in Brandon, Florida

Provider Information

NPI Number: 1588088223
Entity Type: Organization
Organization Name: Dental Assoc of South Brandon
Primary Specialty: Dentist
Enumeration Date: Feb 18, 2014
Last Updated: Feb 18, 2014

Practice Location

Address: 611 E BLOOMINGDALE AVE
Address 2: SUITE C
City: Brandon
State: Florida
ZIP Code: 33511-8127
Phone: (813) 684-6279

Authorized Official

Name: MRS. CRYSTAL B BARRON
Title: INSURANCE SUPERVISOR
Phone: (813) 684-6279

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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