Provider Demographics
NPI:1235396086
Name:MAIDEN, JODY MICHELE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:MICHELE
Last Name:MAIDEN
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 1:2201 4TH ST N
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4300
Mailing Address - Country:US
Mailing Address - Phone:727-823-2007
Mailing Address - Fax:
Practice Address - Street 1:2201 4TH ST N
Practice Address - Street 2:SUITE C
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-4300
Practice Address - Country:US
Practice Address - Phone:727-823-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL169011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice