| Endodontic Innovations | |
|
13127 Kings Lake Dr Suite 101 Gibsonton FL 33534-3958 | |
| (813) 284-7958 | |
| (813) 284-7959 |
| Full Name | Endodontic Innovations |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 13127 Kings Lake Dr, Gibsonton, Florida |
| Authorized Official Name and Position | Thai Vu Pham (DIRECTOR) |
| Authorized Official Contact | 8138026849 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Endodontic Innovations 13127 Kings Lake Dr Suite 101 Gibsonton FL 33534-3958 Ph: (813) 284-7958 | Endodontic Innovations 13127 Kings Lake Dr Suite 101 Gibsonton FL 33534-3958 Ph: (813) 284-7958 |
| NPI Number | 1174070361 |
|---|---|
| Provider Enumeration Date | 09/06/2016 |
| Last Update Date | 08/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174070361 | NPI | - | NPPES |
| 017179500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | DN18558 (Florida) | Primary |
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