Provider Demographics
NPI:1487244596
Name:PALM HARBOR FAMILY DENTISTRY
Entity type:Organization
Organization Name:PALM HARBOR FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-786-8302
Mailing Address - Street 1:3820 TAMPA RD STE 201
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3609
Mailing Address - Country:US
Mailing Address - Phone:727-786-8302
Mailing Address - Fax:727-781-4175
Practice Address - Street 1:3820 TAMPA RD STE 201
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3609
Practice Address - Country:US
Practice Address - Phone:727-786-8302
Practice Address - Fax:727-781-4175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty