| Organization Name: | PEDIATRIC DENTAL ANESTHESIA ASSOCIATES, LLC |
| NPI Number: | 1205099769 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DENNIS R. STONE (PRESIDENT) |
| Mailing Address: | 3408 State Road 13 Saint Johns |
| State: | FL US |
| Postal Code: | 322599270 |
| Phone Number: | 9042303188 |
| Fax Number: | 9042303189 |
| NPI Enumeration Date: | 07/05/2008 |
| NPI Last Update Date: | 07/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | L08000008171 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |