Provider Demographics
NPI:1265838494
Name:ESCOBEDO, CAROLINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CARILLON PKWY
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1290
Mailing Address - Country:US
Mailing Address - Phone:727-299-0728
Mailing Address - Fax:727-209-1365
Practice Address - Street 1:400 CARILLON PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1290
Practice Address - Country:US
Practice Address - Phone:727-299-0728
Practice Address - Fax:727-209-1365
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19517122300000X
NY057733-11223P0221X
FLDN1955171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04061836Medicaid