Provider Demographics
NPI:1003595034
Name:AUR, ROBERTO JORGE JR (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:JORGE
Last Name:AUR
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 GULF BAY BOULEVARD
Mailing Address - Street 2:ROOM 2901 E
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635
Mailing Address - Country:US
Mailing Address - Phone:813-574-5395
Mailing Address - Fax:
Practice Address - Street 1:3400 GULF BAY BOULEVARD
Practice Address - Street 2:ROOM 2901 E
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635
Practice Address - Country:US
Practice Address - Phone:813-574-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDTP791122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist