Provider Demographics
NPI:1063661163
Name:CARTLEDGE, THOMAS H III (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:CARTLEDGE
Suffix:III
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:BRIANNE
Other - Middle Name:C
Other - Last Name:DESANTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:106 N OLD KINGS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9505
Mailing Address - Country:US
Mailing Address - Phone:138-672-4981
Mailing Address - Fax:386-673-1476
Practice Address - Street 1:106 N OLD KINGS RD
Practice Address - Street 2:SUITE C
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9505
Practice Address - Country:US
Practice Address - Phone:138-672-4981
Practice Address - Fax:386-673-1476
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00040711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0740527Medicaid