Provider Demographics
NPI:1164775813
Name:MACEDO, MANOEL ROBERTO (DDS, MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:MANOEL
Middle Name:ROBERTO
Last Name:MACEDO
Suffix:
Gender:M
Credentials:DDS, MS, PHD
Other - Prefix:DR
Other - First Name:ROBERTO
Other - Middle Name:
Other - Last Name:MACEDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS, PHD
Mailing Address - Street 1:5659 NAPLES BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109
Mailing Address - Country:US
Mailing Address - Phone:239-593-2178
Mailing Address - Fax:239-213-1500
Practice Address - Street 1:7801 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1107
Practice Address - Country:US
Practice Address - Phone:727-345-2064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN211241223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics