Basic Information
Provider Information
NPI: 1003299710
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SARWAN
FirstName: PREMATEE
MiddleName: D
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7715 GALL BLVD
Address2: ASPEN DENTAL
City: ZEPHYRHILLS
State: FL
PostalCode: 335414315
CountryCode: US
TelephoneNumber: 8137824200
FaxNumber: 8137828523
Practice Location
Address1: 7715 GALL BLVD
Address2: ASPEN DENTAL
City: ZEPHYRHILLS
State: FL
PostalCode: 335414315
CountryCode: US
TelephoneNumber: 8137824200
FaxNumber: 8137828523
Other Information
ProviderEnumerationDate: 06/30/2015
LastUpdateDate: 06/30/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XDN21402FLY Dental ProvidersDentist 

No ID Information.


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