Provider Demographics
NPI:1710704648
Name:EMERALD DENTAL CARE
Entity type:Organization
Organization Name:EMERALD DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TASNEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHABALLOUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-364-0270
Mailing Address - Street 1:33739 JASPER STONE DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-7339
Mailing Address - Country:US
Mailing Address - Phone:424-421-9102
Mailing Address - Fax:
Practice Address - Street 1:30752 SR 54
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-6009
Practice Address - Country:US
Practice Address - Phone:813-364-0270
Practice Address - Fax:813-364-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental