Deep Roots Dental and Facial Asethetics LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

DEEP ROOTS DENTAL AND FACIAL ASETHETICS LLC

Practice address

3013 Allegra Way
Lutz, FL 33559-6997

Phone

(813) 839-2273

NPI assigned

Dec 16, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Marnie Chall Bauer, DMDNPI 1013124387

Title

Owner

Phone

(813) 839-2273

Specialties & licenses 1

Addresses

Other names 1

• Deep Roots Dental And Facial Asethetics LLC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marnie Chall Bauer, DMD

  • Dentist
  • Tampa, FL
  • NPI 1013124387
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1734307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734307200000",
    "number": "1376350082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4509 W CULBREATH AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336094205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3013 ALLEGRA WAY",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335596997",
            "telephone_number": "813-839-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEEP ROOTS DENTAL AND FACIAL ASETHETICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-16",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A",
        "authorized_official_last_name": "BAUER",
        "authorized_official_first_name": "MARNIE",
        "authorized_official_middle_name": "CHALL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-839-2273",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deep Roots Dental And Facial Asethetics LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katie Davis
• Teresa Lynn Davis
• Xuan De la Torre, PA-C
• Danisbel De Pina Lopez, NEMT
• Payton E Deandrea, RBT
• Robin Lane Dehainaut, MA, BCBA
• Dorothy Del Rio Conde, DMD
• Henry Del Rio Sarduy, RBT-24-355124
• Courtney E Del Rosario, LMHC
• Natalia Del Valle, SLPA

• All providers in Lutz, FL
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.