Provider Demographics
NPI:1861590226
Name:RIDGEMOOR DENTAL ARTS, INC.
Entity type:Organization
Organization Name:RIDGEMOOR DENTAL ARTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-789-8900
Mailing Address - Street 1:4854 RIDGEMOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-1742
Mailing Address - Country:US
Mailing Address - Phone:727-789-8900
Mailing Address - Fax:727-789-1029
Practice Address - Street 1:4854 RIDGEMOOR BLVD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-1742
Practice Address - Country:US
Practice Address - Phone:727-789-8900
Practice Address - Fax:727-789-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty