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12950 Race Track Rd Suite 107 Tampa FL 33626-1309 | |
| (813) 443-5050 | |
| (813) 749-7526 |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 12950 Race Track Rd, Tampa, Florida |
| Authorized Official Name and Position | Brian M. Bivens (PRESIDENT) |
| Authorized Official Contact | 8134435050 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12950 Race Track Rd Suite 107 Tampa FL 33626-1309 Ph: (813) 443-5050 | 12950 Race Track Rd Suite 107 Tampa FL 33626-1309 Ph: (813) 443-5050 |
| NPI Number | 1699072330 |
|---|---|
| Provider Enumeration Date | 02/15/2011 |
| Last Update Date | 02/15/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699072330 | NPI | - | NPPES |
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