| Bespoke Dental | |
|
18713 N Dale Mabry Hwy Ste B Lutz FL 33548-4979 | |
| (813) 807-4902 | |
| (813) 807-4902 |
| Full Name | Bespoke Dental |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 18713 N Dale Mabry Hwy Ste B, Lutz, Florida |
| Authorized Official Name and Position | Tarik Elmohd (ORAL & MAXILLOFACIAL SURGEON/OWNER) |
| Authorized Official Contact | 8135281787 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bespoke Dental 18713 N Dale Mabry Hwy Ste B Lutz FL 33548-4979 Ph: (813) 807-4902 | Bespoke Dental 18713 N Dale Mabry Hwy Ste B Lutz FL 33548-4979 Ph: (813) 807-4902 |
| NPI Number | 1295524411 |
|---|---|
| Provider Enumeration Date | 05/05/2025 |
| Last Update Date | 05/05/2025 |
| Certification Date | 05/04/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295524411 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (NU) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (NU) | Primary |
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