Provider Demographics
NPI:1902434608
Name:ASCEND DENTAL GOUP PA
Entity Type:Organization
Organization Name:ASCEND DENTAL GOUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:TERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-419-0823
Mailing Address - Street 1:12608 BISCAYNE CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-4936
Mailing Address - Country:US
Mailing Address - Phone:813-419-0823
Mailing Address - Fax:
Practice Address - Street 1:4400 BAYOU BLVD STE 44A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-1910
Practice Address - Country:US
Practice Address - Phone:850-857-8427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-29
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty