Provider Demographics
NPI:1730923814
Name:ST. PETERSBURG DENTAL IMPLANT CENTER
Entity type:Organization
Organization Name:ST. PETERSBURG DENTAL IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:VELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-437-8232
Mailing Address - Street 1:5637 49TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2105
Mailing Address - Country:US
Mailing Address - Phone:301-437-8232
Mailing Address - Fax:727-354-4016
Practice Address - Street 1:5637 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2105
Practice Address - Country:US
Practice Address - Phone:301-437-8232
Practice Address - Fax:727-354-4016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental