Provider Demographics
NPI:1073199634
Name:MACHADO, ANA CAROLINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:CAROLINA
Last Name:MACHADO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 N ALATAMAHA ST
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3684
Mailing Address - Country:US
Mailing Address - Phone:512-822-0063
Mailing Address - Fax:
Practice Address - Street 1:9109 BAYMEADOWS RD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1842
Practice Address - Country:US
Practice Address - Phone:904-731-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25654122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist